15250-m-cuypers

58 Chapter 3 4.5 Future studies Based on the changes in HRQoL we found in this study, future studies should focus on determining the impact of the individual aspects of undergoing biopsy, receiving Pca diagnosis, and selecting treatment. Compared to the current design, this would require an additional measurement in between receiving diagnosis and making a treatment decision. Furthermore, the current study did not follow-up on patients with a negative biopsy result. To have a complete comparison of HRQoL after prostate biopsy, post-biopsy HRQoL should also be compared between patients with a positive and patients with a negative biopsy result. Recently, a prospective study found similar HRQoL before and after diagnosis between Pca patients on AS and a non-cancer control group, indicating HRQoL of patients on AS is similar to that of patients without cancer 44 . However, it would be interesting to investigate if decisional self-efficacy is still associated to HRQoL outcomes when no treatment decision has to be made. 4.4 Clinical implications This study emphasizes the impact of undergoing prostate biopsy, receiving a Pca diagnosis, and selecting treatment. Clinicians’ should be aware that optimism and decisional self-efficacy are associated to HRQoL prior to treatment onset. To ensure that optimism does not backfire post-treatment, it is important to ensure accurate risk perceptions in patients about the chances of treatment success and the occurrence of treatment side-effects. Interventions to stimulate shared decision-making, like decision aids, could be helpful for achieving this, as well as to contribute to patients’ decisional self-efficacy levels 45 . 4.5 Conclusion So far, most studies investigating HRQoL in Pca patients have focused on the impact of treatment, while neglecting the psychological burden caused by diagnosis and the treatment selection process. This study showed that prior to treatment onset, patients reported reduced functioning, more symptoms and lower overall global health, in particular if a curative treatment was selected. During clinical counseling, managing optimism when Pca is suspected (before and after biopsy) and (decisional) self-efficacy when Pca is confirmed, could help to reduce the pre-treatment impact on HRQoL.