Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study

Abstract

AbstractObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment.ConclusionsThough an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.Key MessagesWhat is already known about this subject?Partial gland ablation (PGA) is an emerging treatment option for prostate cancer (PCa) that allows for the targeting of areas of biopsy proven PCa with the goal of minimizing treatment-related morbidity by avoiding treatment of non-cancerous areas of the prostate. We sought to explore patients’ beliefs and attitudes toward partial gland ablation.What are the new findings?We define treatment attributes that are significant to men with localized PCa, and one important theme is of the treatment intensity matching the severity of the disease. PGA appeals to men as middle ground that encompasses the duality of curative treatment and preservation of quality of life.How might these results affect future research or surgical practice?The exploratory themes need further exploration and may be incorporated into shared decision-making discussions in men with low-risk disease, as PGA emerges as a treatment option.