15250-m-cuypers

56 Chapter 3 4. DISCUSSION This study investigated the HRQoL impacts of undergoing prostate biopsy, receiving Pca diagnosis and choosing treatment. Prior to prostate biopsy, when Pca is suspected but not yet confirmed, HRQoL was similar between patients who were later confirmed to have Pca and patients without Pca. When a Pca diagnosis was received, and treatment was chosen but had not yet started, patients reported more symptoms and reduced functioning compared to the pre-biopsy baseline. HRQoL at baseline did not predict treatment choice, but patients who chose a curative treatment instead of AS, reported more symptoms and reduced functioning compared to patients who chose AS. Overall global health at baselinewas related to optimism , after diagnosis and treatment selection an association with decisional self-efficacy was found. 4.1 HRQoL outcomes Differences in HRQoL between patients who selected curative treatment over AS is not surprising. Men eligible for AS could be expected to be in a more favorable condition compared tomenwho need (immediate) curative treatment 33 . However, it is remarkable that most HRQoL differences were not present in our sample at baseline, but were only reported after diagnosis and treatment selection. Moreover, the highest level of urinary symptoms at t0 were reported by men who later selected AS, while after the treatment decision was made, most symptoms were reported by men who selected a curative treatment. Therefore, changes in HRQoL appear to be influenced by the impact of diagnosis and treatment decision-making, rather than by changes in the patient’s physical condition. Possibly, the Pca diagnosis mademenmore aware of their symptoms and led them to attribute their overall condition more to their disease. Increased symptom burden and impaired functioning at t1 could also be explained by cognitive dissonance reduction 34 ; consequently of a finalized treatment decision, men could be motivated to justify this decision as being the right one. This could have resulted in a revised HRQoL evaluation at t1 to make it consonant with the characteristics that would fit to the selected treatment 35, 36 . If biopsy itself caused a decline in HRQoL, all patients should have reported lower HRQoL at t1, while this was only the case for patients who chose a curative treatment, patients from the AS group even reported (non-significant) improvements 37 . Earlier studies on physical and psychological outcomes in Pca patients highlighted the perceived masculinity threat men could experience 38, 39 . This threat affects how men cope with their condition and the perceived threat could cause a further decline of HRQoL after treatment. Althoughmost of thework onmasculinity threats in Pca patients focused on post-treatment outcomes, it is likely that this perceived threat is already