Patient's choice of observational strategy for early-stage prostate cancer

Active Surveillance (AS) may represent for selected patients with low risk, potentially indolent prostate cancer (PCa) a viable alternative to radical therapies, thus reducing the risk of over-treatment.Researchers and clinicians emphasized that the choice of AS may be acontroversial one as patients have the chance to avoid the side effects of radical therapies but also the burden of living with an untreated PCa. The aim of our study is to focus on the decision-making process leading patients to elect AS amongst different therapeutic options.An observational, qualitative study was conducted. Between 2007 and 2009, 46 patients (mean age 67 years) were administered a semi-structured interview at enrolment in the Prostate Cancer Research International: Active Surveillance protocol. The focus of the interview was onthe first question, i.e. "Why did you choose AS?". Interviews were audio-recorded and verbatim transcriptions were made. Content analyses were performed by using a text-driven, automatic software (T-lab). Four clusters of themes emerged. In cluster 1, the most meaningful theme was the ambivalence in front of different therapeutic options. In cluster 2, the focus was on patients' assessment of the aggressivenessof their PCa. In cluster 3, the topic was the collection of information from specialists. In cluster 4, the main theme was the collection of data through informal sources. Patients are motivated to opt for AS based on the subjective evaluation of medical information as well as characteristics of their psycho-social context. Understanding motivation for AS will help clinicians support patients in making the bestchoice for them.