Patients' survival expectations before localized prostate cancer treatment by treatment status.

BACKGROUND Cancer-specific mortality is projected to be only 1% in 15 years in approximately 75% of patients with screen-detected localized prostate cancer (LPC). Nearly 94% of patients choose treatment even though treatment damages health-related quality of life. No data are available regarding what survival benefit patients expected from treatment. OBJECTIVES A self-administered mailed survey was sent to 184 men with newly diagnosed LPC to query patients about expected survival with treatment versus observation. RESULTS More than 90% of patients had at least a high school education and a ninth-grade health literacy. In addition, 68% patients had income of > or =$50,000. Mean cancer grade was 6.6. Twenty-three patients chose observation and 161 patients chose surgery or radiotherapy. Mean comorbidity adjusted life expectancy (CALE) without the cancer was 22.9 years. Without cancer treatment, 15.2% of patients expected to live <5 years, 48.8% 5 to 10 years, 33.5% 11 to 19 years, and 2.4% > or =20 years. With treatment, survival expectations were <5 years in 0.6%, 5 to 10 years in 6.5%, 11 to 19 years in 30.0%, and > or =20 years in 62.9% of patients. Age, prostate-specific antigen level, CALE, anxiety, depression, and social support were factors that predicted differences between CALE and patient survival expectations with and without treatment. CONCLUSION LPC patients grossly underestimated their life expectancy without treatment and grossly overestimated the survival benefit of treatment.