During uncertain illness situations, men tried to make sense of signs and symptoms based on previous experience, according to results of a study published in the European Journal of Cancer Care.

Life prolonging therapy for metastatic castration-resistant prostate cancer (mCRPC) became available in 2004. Since that time, survival has been extended by more than 30 months; however, these patients often experience substantial symptom burden during that time. To evaluate how men with mCRPC interpret signs and symptoms, 11 men receiving life-prolonging treatment in Sweden participated in 30 longitudinal interviews.

Study participants were median age 75 years (range, 60 to 89), diagnosis was made a median 33 months (range, 10 to 122) previously, and prostate-specific antigen (PSA) level was a median 90 ng/mL (range, 8.2 to 425) at the first interview.

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All the men were aware they had an incurable disease.

When new symptoms arose, the participants interpreted that as potential disease progression. Men who experienced pain as the first symptom of their cancer related new pain with a potential metastasis event.

Some men interpreted side effects of treatments as signs their treatment was working. This relationship led some patients to be disappointed when treatment was not having the expected effect.

Certain symptoms triggered thoughts about the end of their life, related to fear of death/dying, becoming dependent on others, and the impact on their family.

In general, the men thought their PSA values were more meaningful than other results. For example, if their imaging results were good but their PSA was increasing, they did not feel relieved by the good imaging findings.

This study was limited by its small size and findings may not be generalizable to all patients.

These data indicated that men with mCRPC related signs and symptoms with past experience during uncertain times sometimes leading to erroneous relationships between symptoms and prognosis and disappointment.


Rönningås U, Holm M, Doveson S, Fransson P, Beckman L, Wennman-Larsen A. Signs and symptoms in relation to progression, experiences of an uncertain illness situation in men with metastatic castration-resistant prostate cancer — a qualitative study. Eur J Cancer Care. 2022;e13592. doi:10.1111/ecc.13592