Active surveillance for prostate cancer—The lived experience. A systematic review and metasynthesis

Active surveillance for prostate cancer—The lived experience. A systematic review and metasynthesis

Background: Prostate Cancer is one of the most prevalent cancers to impact men worldwide.1 Active surveillance (AS) is accepted as a recommended treatment option for some forms of localised prostate cancer. However, concerns have been raised about the toll this treatment can have on men, highlighted by the approximately 40% of men that cease active surveillance without clinical indication and despite comparable survival outcomes.2

Aim: The aim of this review is to explore the survivorship needs of men with prostate cancer undergoing AS.

Methods: A systematic review and meta-synthesis of qualitative studies was undertaken according to PRISMA guidelines in conjunction with a three-stage thematic synthesis (categorising, distilling, and developing new meaning from the data). Studies were included if they reported the lived experience of men who had commenced AS, without having undergone any previous treatment(s). Studies were excluded if they included participants that had undergone previous treatment for their prostate cancer, addressed clinical needs, as opposed to survivorship needs or reported data on men on watchful waiting, unless data for men on active surveillance was able to be clearly extrapolated.

Results: Thirteen studies met the inclusion criteria from 3226 studies, garnered from five databases. Two key themes were identified; confidence in active surveillance as a treatment and impacts of active surveillance on wellbeing. Living with an untreated cancer, ongoing surveillance requirements and feelings of isolation adversely impact wellbeing. To counter, men employ both proactive and avoidant coping strategies. Underpinning men's confidence and wellbeing is a hierarchy of unmet information needs influenced by therapeutic relationships with the treating team and the impact of discordant terminology undermining the required diligence for adherence to a surveillance protocol.

Conclusion: There are multiple factors influencing men's lived experience on AS. It is imperative to understand the specific survivorship care needs of this cohort to enable optimal support provision for men on AS and promote adherence to treatment. Further research into understanding men's unmet survivorship needs is essential.

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