Research ArticleOriginal Research

Patients’ Survival Expectations before Localized Prostate Cancer Treatment by Treatment Status

Ravinder Mohan, Hind Beydoun, Myra L. Barnes-Ely, LaShonda Lee, John W. Davis, Raymond Lance and Paul Schellhammer
The Journal of the American Board of Family Medicine May 2009, 22 (3) 247-256; DOI: https://doi.org/10.3122/jabfm.2009.03.080200

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Tables

  • Table 1.

    Comparison of Sociodemographic Characteristics of Patients with Localized Prostate Cancer who Chose Treatment* and Observation†

    CharacteristicOverall (n [%])Treatment (n [%])Observation (n [%])P‡
    Age (years)n = 184n = 161n = 23
        <6071 (38.6)68 (42.2)3 (13.0)
        60–7091 (49.5)81 (50.3)10 (43.5)
        >7022 (11.9)12 (7.5)10 (43.5)<.0001
        Mean ± SD61.5 ± 7.960.6 ± 7.668.2 ± 5.9<.0001
    Racen = 184n = 161n = 23
        African American26 (14.1)26 (16.2)0 (0.0)
        White158 (85.9)135 (83.9)23 (100).05§
    Educationn = 180n = 157n = 23
        <High school7 (3.9)7 (4.5)0 (0.0)
        High school65 (36.1)56 (35.7)9 (39.1)
        College108 (60.0)94 (59.9)14 (60.9).58
    Health literacyn = 173n = 150n = 23
        Below 6th grade1 (0.6)1 (0.7)0 (0.0)
        6th-9th grade16 (9.3)15 (10.0)1 (4.4)
        >9th grade156 (90.2)134 (89.3)22 (95.7).63
    Family incomen = 179n = 156n = 23
        Low (<$50,000)57 (31.8)50 (32.0)7 (30.4)
        High (≥$50,000)122 (68.2)106 (67.9)16 (69.6).88

    • * Treatment patients had either surgery or radiotherapy.

    • † Observation patients had neither surgery nor radiotherapy.

    • ‡ Unless otherwise specified, statistical significance is for χ2 test (categorical variables) or independent samples t test (continuous variable).

    • § Fisher's exact test.

  • Table 2.

    Comparison of Patients who Chose Treatment and Observation by Prostate Cancer-Related and Health Factors

    FactorsOverall (n [%])Treatment (n [%])Observation (n [%])P*
    Gleason Graden = 184n = 161N = 23
        2–40 (0.0)0 (0.0)0 (0.0)
        5–6103 (55.9)84 (52.1)19 (82.6)
        762 (33.7)60 (37.3)2 (8.7)
        8–1019 (10.3)17 (10.6)2 (8.7)0.02
        Mean ± SD6.6 ± 0.76.6 ± 0.76.2 ± 0.70.02
    Prostate-specific antigen testn = 183n = 161n = 23
        ≤10159 (86.9)139 (86.3)21 (91.3)
        >1024 (13.1)22 (13.7)2 (8.7)0.74
        Mean ± SD6.7 ± 5.36.8 ± 5.55.6 ± 3.40.14
    Life expectancy by age (years)n = 183n = 160N = 23
        <104 (2.2)2 (1.3)2 (8.7)
        10–20104 (56.8)86 (53.8)18 (78.3)
        ≥2075 (40.9)72 (45.0)3 (13.0)0.002*
    Comorbidity scoren = 184n = 161N = 23
        074 (40.2)66 (40.9)8 (34.8)
        175 (40.8)67 (41.6)8 (34.8)
        227 (14.7)23 (14.3)4 (17.4)
        ≥38 (4.4)5 (3.1)3 (13.0)0.16
        Mean ± SD0.9 ± 1.00.83 ± 0.961.26 ± 1.50.18
    Short Form-36 subscales
        Physical component summaryn = 142n = 134n = 8
            Mean ± SD54.5 ± 7.654.5 ± 7.252.6 ± 12.30.66
        Mental component summaryn = 142n = 134n = 8
            Mean ± SD44.1 ± 6.843.9 ± 6.946.4 ± 4.50.29
    Prostate cancer index
        Urinaryn = 141n = 132n = 9
            Mean ± SD90.2 ± 16.990.1 ± 17.491.3 ± 9.30.83
        Boweln = 142n = 133n = 9
            Mean ± SD88.8 ± 12.588.5 ± 12.892.9 ± 4.50.03
        Sexualn = 137n = 128n = 9
            Mean ± SD57.7 ± 29.957.8 ± 30.455.4 ± 23.80.82
        Urinary Bothern = 144n = 135n = 9
            Mean ± SD86.1 ± 23.085.9 ± 23.488.9 ± 18.20.71
        Bowel Bothern = 144n = 135n = 9
            Mean ± SD92.5 ± 17.592.0 ± 17.9100 ± 0.0<0.0001
        Sexual Bothern = 142n = 133n = 9
            Mean ± SD65.8 ± 36.865.4 ± 36.872.2 ± 38.40.59
    Fear of cancer recurrencen = 141n = 133n = 8
        Mean ± SD10.7 ± 3.810.7 ± 3.710.9 ± 4.50.92
  • Table 3.

    Distribution of Men by Prostate Cancer-Related and Health Characteristics

    CharacteristicOverall (n [%])Treatment (n [%])* **Observation (n [%])† ***P‡*
    Comorbidity adjusted life expectancy (CALE)
        All ages184 (100)161 (100)23 (100)
         <5 years1 (0.5)0 (0)1 (4.3)
        5–10 years4 (2.2)2 (1.2)2 (8.7)
        11–19 years67 (36.4)52 (32.3)15 (65.2)
        ≥20 years112 (60.9)107 (66.5)5 (21.7)<.0001
        Mean ± SD22.9 ± 7.623.9 ± 7.316.4 ± 5.7<.0001
    Anxiety scoren = 183n = 160n = 23
        None/normal (0–7)145 (79.2)123 (76.9)22 (95.7)
        Mild anxiety (8–10)23 (12.6)23 (14.4)0 (0.0)
        Moderate anxiety (11–14)12 (6.6)11 (6.9)1 (4.4)
        Clinical (15–21)3 (1.6)3 (1.9)0 (0.0).18
        Mean ± SD5.1 ± 3.55.4 ± 3.52.8 ± 2.9.0008
    Depression scoren = 178n = 156n = 22
        None/normal (0–7)172 (96.6)150 (96.2)22 (100)
        Mild depression (8–10)4 (2.3)4 (2.6)0 (0.0)
        Moderate (11–14)1 (0.6)1 (0.6)0 (0.0)
        Clinical (15–21)1 (0.6)1 (0.6)0 (0.0).83
        Mean ± SD1.7 ± 2.31.7 ± 2.41.4 ± 1.7.49
    Functional capacityn = 184n = 160n = 23
        Mild activities (<3 METs)1 (0.5)1 (0.6)0 (0.0)
        Moderate activities (3–6 METs)20 (10.9)15 (9.3)5 (21.7)
        Vigorous activities (≥6 METs)163 (88.6)145 (90.1)18 (78.3).19
    Social supportn = 183n = 160n = 23
        <507 (3.8)6 (3.8)1 (4.4)
        50–7533 (18.0)29 (18.1)4 (17.4)
        75–100143 (78.1)125 (78.1)18 (78.3).98
    Satisfaction with Lifen = 178n = 156n = 22
        Delighted or highly satisfied138 (77.5)121 (77.6)17 (77.3)
        Satisfied or lower40 (22.5)35 (22.4)5 (22.7).97
        Mean ± SD6.0 ± 0.95.9 ± 0.96.1 ± 1.0.64
    Satisfaction with healthn = 178n = 156n = 22
        Delighted or highly satisfied85 (47.8)72 (46.1)13 (59.1)
        Satisfied or lower93 (52.3)84 (53.9)9 (40.9).26
        Mean ± SD5.0 ± 1.35.0 ± 1.35.4 ± 1.4.19
    Satisfaction with education by physiciann = 178n = 156n = 22
        Delighted or highly satisfied141 (79.2)126 (80.8)15 (68.2)
        Satisfied or lower37 (20.8)30 (19.2)7 (31.8).17
        Mean ± SD6.1 ± 0.96.1 ± 0.95.9 ± 1.1.1

    • * Treatment patients had either surgery or radiotherapy.

    • † Observation patients had neither surgery nor radiotherapy.

    • ‡ Unless otherwise specified, statistical significance is for χ2 test (categorical variables) or independent samples t test (continuous variable).

    • MET, metabolic equivalent.

  • Table 4.

    Distribution of Men with Localized Prostate Cancer by Calculated Comorbidity Adjusted Life Expectancy

    Expected Survival (years)Baseline CALE Score (n = 184)Q1 (n = 170)Q2 (n = 170)
    <51 (0.5)26 (15.2)1 (0.6)
    5–104 (2.2)83 (48.8)11 (6.5)
    11–1967 (36.4)57 (33.5)51 (30.0)
    ≥20112 (60.9)4 (2.4)107 (62.9)

    • Data provided as n (%).

    • CALE, comorbidity adjusted life expectancy; Q1, How long do you expect you will live without any treatment for prostate cancer?; Q2, How long do you expect you will live after the treatment of your choice for prostate cancer?

  • Table 5.

    Ordinal Logistic Regression Modeling for Perceived Decrease in Longevity with Observation (PDLO) among Men with Localized Prostate Cancer

    Unadjusted EffectsAdjusted Effects OR (95% CI)
    PDLO ≤0*PDLO = 1†PDLO ≥2‡OR (95% CI)
    Age2562831.08 (1.04–1.13)1.01 (0.92–1.10)
    PSA level2562820.94 (0.88–1.00)0.93 (0.86–1.00)
    CALE2562830.92 (0.88–0.96)0.93 (0.84–1.02)
    Anxiety score2562830.88 (0.81–0.96)0.96 (0.85–1.08)
    Depression score2558820.79 (0.67–0.93)0.85 (0.69–1.04)

    • * A (PDLO) ≤0 (reference group) indicates that CALE and self-reported survival expectation without treatment are within the same range or CALE is less.

    • † A (PDLO) = 1 suggests that CALE exceeds self-reported survival expectation without treatment by one response category.

    • ‡ A (PDLO) ≥2 suggests that CALE exceeds self-reported survival expectation without treatment by at least 2 response categories (ie., about 10 years). All covariates in the ordinal logistic regression model are defined as continuous variables.

    • PDLO, perceived decrease in longevity with observation (categorized); PSA, prostate-specific antigen; CALE, comorbidity adjusted life expectancy; OR, odds ratio.

  • Table 6.

    Ordinal Logistic Regression Modeling for Perceived Increase in Longevity with Treatment (PILT) among Men with Localized Prostate Cancer

    Unadjusted effectsAdjusted effects OR (95% CI)
    PILT ≤0*PILT = 1†PILT ≥2‡OR (95% CI)
    Age1887651.08 (1.04–1.13)1.09 (0.99–1.19)
    CALE1887650.93 (0.89–0.97)1.02 (0.93–1.12)
    Anxiety score1887650.89 (0.82–0.98)0.91 (0.81–1.02)
    Depression score1883640.93 (0.82–1.05)1.06 (0.89–1.26)
    Social support1887651.01 (0.99–1.03)1.00 (0.98–1.02)

    • * PILT ≤0 (reference group) indicates that CALE and self-reported survival expectation with treatment are within the same range or CALE is less.

    • † A (PILT) = 1 suggests that CALE exceeds self-reported survival expectation with treatment by one response category.

    • ‡ A (PILT) ≥2 suggests that CALE exceeds self-reported survival expectation with treatment by at least 2 response categories (ie., about 10 years). All covariates in the ordinal logistic regression model are defined as continuous variables.

    • PILT, perceived increase in longevity with treatment (categorized); CALE, comorbidity adjusted life expectancy; OR, odds ratio.

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