Anxiety and distress during active surveillance for early prostate cancer

This study found that the majority of men with early prostate cancer (PC) included in a protocol-based program for active surveillance (AS) show favorable anxiety and distress scores when compared to reference values and to groups of patients with PC who underwent other treatments. A perceived important role of the physician in the shared treatment decision-making, a poor physical health score, a high neuroticism score, and a high PSA value were found to be significantly linked with worse scores on decisional conflict, depression, generic anxiety, and PC specific anxiety.

This research aimed to further discuss the relevance, and the strengths and limitations of this study and discuss the future research directions.

What is the relevance of the conclusions of this study for clinical urological practice? Recent results show that the potential disadvantage of AS regarding the burden of living with untreated cancer is small in men who have chosen this prostate cancer tretment options. This adds to the feasibility of AS as a realistic strategy for men diagnosed with low risk PC. Equally important, awareness that patient-related factors are associated with levels of anxiety and distress may be useful in the shared treatment decision-making process in general, or in the selection of patients for AS.

A strength of the present study is the high compliance rate of 86%. The authors used an extensive questionnaire consisting mainly of standardized measures, allowing the simultaneous collection of many different relevant parameters. Furthermore, implementing the quality of life study within the prospective PRIAS study (www.prias-project.org) allowed a directly prospective approach to all participants. The relatively short follow-up after PC diagnosis of a median of 2.7 months decreases the bias of selecting only those patients with a favorable clinical follow-up.

This study also has its limitations too. Firstly, it focused on a selected patient group who had already selected AS to be the initial treatment strategy for their disease. They may have made this decision because they experienced low levels of anxiety and distress. The results of the present study should therefore not be generalized to patients with early PC before the treatment decision. Another limitation of this study is the lack of comparison groups within the same protocol. Instead, scores were compared with reference values and patient cohorts from the literature. Finally, as the current study design was cross-sectional, the predictive value of the parameters found to be significantly related to anxiety and distress could not be determined.



NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment.





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