Anxiety And Distress During Active Surveillance For Early Prostate Cancer

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Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology;  Psychology / Psychiatry
Article Date: 26 Sep 2009 - 0:00 PDT

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UroToday.com - Men with low-risk prostate cancer (CaP) who are candidates for active surveillance (AS) often choose definitive therapy due to anxiety over their untreated cancer. In the September 1, 2009 issue of Cancer, a group of researchers from the Netherlands assessed anxiety and distress during AS for CaP.

This study included patients enrolled in the protocol-based AS program of the international prospective Prostate Cancer Research International: Active Surveillance (PRIAS) study. Inclusion criteria were PSA <10ng/ml, PSAD <0.2ng/mL/mL, nonpalpable or localized CaP, no more than 2 positive needle biopsy cores and a Gleason score of <6(3+3). Between 2007 and 2008 150 men who entered the PRIAS study received a QoL questionnaire. Decisional conflict on the choice for AS was assessed with the Decisional Conflict Scale (DCS) which consists of 16 items with 5 response options each. A score of 100 indicates maximum decisional conflict, scores <25 are associated with implementing the decision and scores >37.5 are associated with decision delay or feeling unsure regarding implementation. Other parameters assessed included depression, general anxiety, CaP-specific anxiety, general health, personality, involvement in the physician decision-making process, and knowledge of CaP.

The response rate was 129 of 150 questionnaires sent (86%). DCS scores were lower than the reference value for decision delay or feeling unsure regarding implementation, 37% (81 of 129 respondents) also had scores below the reference value associated with problems in implementing the decision, 92% (119 of 129 men) had scores lower than the reference value for depression, 83% (107 of 129 men) had scores lower than the reference value for clinical anxiety, and 93% (120 of 129 men) had scores lower than the reference value for clinically significant CaP-specific anxiety. A total of 83 men (64.3%) scored below the reference value on all 4 main variables.

In multivariable analysis, the role of the physician in the shared decision-making process remained associated with higher DCS scores. This suggests that the majority of men undergoing AS had favorable anxiety and distress scores compared with reference values and compared with groups of patients with CaP in other studies who underwent active treatments.

van den Bergh RC, Essink-Bot ML, Roobol MJ, Wolters T, Schröder FH, Bangma CH, Steyerberg EW
Cancer. 2009 Sep 1;115(17):3868-78.
doi:10.1002/cncr.24446

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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