Tag Archive for: Michigan Prostate Cancer Survivor Study


Article of the Week: Symptom Burden and Information Needs in PCa Survivors

Every Week the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one.

Symptom burden and information needs in prostate cancer survivors: a case for tailored long-term survivorship care

Jennifer K. Bernat*, Daniela A. Wittman, Sarah T. Hawley, Daniel A. HamstraAlexander M. Helfand, David A. Haggstrom*, May Darwish-Yassine‡ and Ted A. Skolarus


*Indiana University, Indianapolis, IN, University of Michigan, Ann Arbor, Michigan Public Health Institute, Okemos, and §VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA



To determine the relationship between long-term prostate cancer survivors’ symptom burden and information needs.

Patients and Methods

We used population-based data from the Michigan Prostate Cancer Survivor Study (2499 men). We examined unadjusted differences in long-term information needs according to symptom burden and performed multivariable logistic regression to examine symptom burden and information needs adjusting for patient characteristics.



High symptom burden was reported across all domains (sexual 44.4%, urinary 14.4%, vitality 12.7%, bowel 8.4%, emotional 7.6%) with over half of respondents (56%) reporting they needed more information. Top information needs involved recurrence, relationships, and long-term effects. Prostate cancer survivors with high symptom burden more often searched for information regardless of domain (P < 0.05). High sexual burden was associated with greater need for information about relationships [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.54–2.72] and long-term effects (OR 1.60, 95% CI 1.23–2.07). High bowel burden was associated with greater information need for long-term effects (OR 2.28, 95% CI 1.43–3.63).


Long-term prostate cancer survivors with high symptom burden need more supportive information. Tailoring information to these needs may be an efficient approach to support the growing population of long-term prostate cancer survivors.

Editorial: Tailored prostate cancer survivorship: one size does not fit all

One of the great triumphs in Urology is the transition of prostate cancer surgery from a universally morbid operation to one that now focuses on postoperative quality of life. This paradigm of cancer survivorship focuses on managing new, recurrent, or persistent symptoms. In this article by Bernat et al. [1], men within the Michigan Prostate Cancer Survivor Study were surveyed to identify factors that increase the need for additional prostate cancer survivorship information. Previous studies have shown discrepancies between subsets of prostate cancer survivors, based upon social, pathological, and treatment-based factors [2-5]. Indeed, the need for improved patient-centric information for all cancer survivors has resulted in the American Cancer Society publishing guidelines on how to best manage prostate cancer survivors, which account for four of every 10 male cancer survivors [6].

The authors [1] identify several critical aspects of post-treatment prostate cancer survivors. First, more than half of patients needed more information about their symptoms. This may be a departure from the views of many urological surgeons, who believe their patients are symptom-free after treatment. Second, the information needs of respondents were intuitively tied to their specific symptoms. For example, men who received combined therapy – thus, suggesting concern for incomplete control with primary treatment – were more concerned about recurrence; married men were more concerned about the effects of prostate cancer on their significant other; and men with more profound bowel or sexual symptom burdens were more concerned about the long-term effects and recovery period. Third, prostate cancer survivors remain concerned about diagnosis and treatment of their disease, even after they have received curative treatment. Topics such as early detection, diagnosis, and prevention of cancer were identified in double-digit percentages of respondents. Finally, there exists a correlation between the severity of symptom burden and associated information needs. A subset of symptoms (urinary, sexual, and bowel) may be directly related to treatment techniques and technologies. Thus, improvements in these fields may have long-term survivorship benefits.

While enlightening, these results are nevertheless susceptible to the inherent limitations of a survey-based study. Selection bias suggests that the true range of information needs and associated symptom burdens are not completely captured in these results. Additionally, these findings are not subdivided based on pathological stage or treatment method, which probably play important roles in cancer treatment, post-treatment symptoms, and patient concerns.

What are we to do with the results presented in this report? Clearly, easy access to informational resources about cancer survivorship needs to be offered as a standard of care for men with prostate cancer, which should be initiated before starting treatment. Additionally, men who are at-risk for requiring additional information on cancer survivorship (non-White race, received multimodality treatment, recurrent cancer, or high symptom burden) should receive additional counselling to ensure their informational needs are met. Finally, studies validating the effectiveness of these resources should be studied prospectively. Just as no two prostates are the same, so too should the paradigm be for prostate cancer treatment and survivorship.

Michael H. Johnson


Department of Urology, The James Buchanan Brady Urological Institute, Baltimore, MD, USA



2 Hudson SV, OMalley DM, Miller SM. Achieving optimal delivery of follow-up care for prostate cancer survivors: improving patient outcomes. Patient Relat Outcome Meas 2015; 6: 7590


3 Bourke L, Boorjian SA, Briganti A et al. Survivorship and improving quality of life in men with prostate cancer. Eur Urol 2015; 68: 37483


4 Chamie K, Connor SE, Maliski SL, Fink A, Kwan L, Litwin MS. Prostate cancer survivorship: lessons from caring for the uninsured. Urol Oncol


2012; 30: 1028
5 AmericanCancerSociety. National Cancer Survivorship Resource Center. Avaliable at: https://www.cancer.org/survivorshipcenter. Accessed October 2015


6 Gore JL, Kwan L, Lee SP, Reiter RE, Litwin MS. Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer. J Natl Cancer Inst 2009; 101: 88892


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