INTRODUCTION AND OBJECTIVE:
Despite consensus guidelines, many men with low-grade prostate cancer are not managed with active surveillance. Patient perception of the nomenclature used to describe low-grade prostate cancers may partly explain this discrepancy.
A randomized online survey was administered to men without a history of prostate cancer, presenting a hypothetical clinical scenario where the man is given a new diagnosis of low-grade prostate cancer. Using three terms for low-grade prostate cancer, “Gleason 6 out of 10 prostate cancer”, “Grade group 1 out of 5 prostate cancer”, or “Indolent lesion of epithelial origin,” we tested whether diagnosis nomenclature was associated with management preference and diagnosis-related anxiety immediately following the diagnosis and after receiving disease-specific education. Ratings were made on a 1-to-100 scale and adjusted for participant characteristics through multivariable linear regression.
Of the 718 participants, 648 were White (90.2%) and the mean age was 61 (standard deviation 11) years. Most participants were college educated and approximately half had annual incomes >$75,000. There were no differences in baseline characteristics between groups. Compared to “Gleason 6 out of 10 prostate cancer,” the term “Grade Group 1 out of 5 prostate cancer” was associated with lower preference for immediate treatment versus active surveillance (b=–9.3, 95% CI [–14.4 to –4.2], p<0.001) and lower diagnosis-related anxiety (b=-8.3, 95% CI [-12.8 to -3.8], p<0.001) at time of initial diagnosis. Differences decreased as participants received more disease-specific education. “Indolent lesion of epithelial origin,” a suggested alternative term for indolent tumors, was not associated with differences in anxiety or preference for active surveillance.
Within a hypothetical clinical scenario, nomenclature for low-grade prostate cancer affects initial perception of the disease and may alter subsequent decision-making, including preference for active surveillance. Disease-specific education reduces the differential impact of nomenclature use, reaffirming the importance of comprehensive counseling between the clinician and patient.
Source of Funding:
SPORE prostate cancer P50 CA180995