Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable‐risk prostate cancer patients: A 9‐month longitudinal study

Abstract

Objective This study aimed to explore the psychological impact of favorable‐risk prostate cancer (PCa) and associated treatment (active surveillance [AS] or active treatment [AT]), comparing prevalence and temporal variability of generalized anxiety, PCa‐specific anxiety, and depression symptoms. Methods PCa patients were recruited at diagnosis prior to treatment decision‐making and completed questionnaires assessing anxiety (State‐Trait Anxiety Inventory short form [STAI‐6] and Memorial Anxiety Scale for Prostate Cancer [MAX‐PC]) and depression symptoms (Centre for Epidemiologic Studies Depression Scale [CES‐D]) at four timepoints for 9 months. Non‐cancer controls were recruited via university staff lists and community groups. Results were analyzed using analysis of variance. Results Fifty‐four PCa (AS n = 11, AT n = 43) and 53 non‐cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES‐D scores (P > .05). The main effect of treatment on STAI‐6 scores was significant (F2,73 = 4.678, .012) with AS patients reporting highest STAI‐6 scores (T1 M = 36.56; T2 M = 36.89, T3 M = 38.46; T4 M = 38.89). There was a significant main effect for time since diagnosis on MAX‐PC (F3,123 = 3.68, .01); AS patient scored higher than AT at all timepoints (T1 M = 10.33 vs 10.78; T2 M = 11.11 vs 11.30; T3 M = 13.44 vs 10.55; T4 M = 11.33 vs 8.88); however, both groups declined overall with time. Conclusions Men undergoing AS had significantly higher anxiety symptoms than AT and non‐cancer participants, contradicting previous literature. This may be due to perceived inactivity of AS relative to traditional narratives of cancer treatment. Participant experiences appear to be less favorable relative to other international centers. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision particularly for lower risk patients.

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

“…Unmet emotional/psychological needs were reflected in men's fears/worries associated with cancer, feelings of uncertainty in relation to AS and unmet information needs, and the accessibility of appropriate support groups/resources specific to men on AS. While research comparing men on AS with men who have received curative PCa treatment generally show that depression and anxiety are comparable and scores decrease over time, recent research suggests anxiety may be higher in men on AS. In line with this recent research, the present analysis suggests some men may be inadequately supported psychologically/emotionally.…”

Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study

“…[41] One study prospectively measuring anxiety for 9 months has found higher levels of distress among men on AS than those on AT, which was attributed to men being followed at a center without a strong focus on AS. [42] The absence of anxiety expressed by our contemporary cohort suggests that the benefits of AS are being appreciated while the potential risks are being minimized. Other studies have shown that men made lifestyle changes, including undertaking complementary and alternative medicine treatments, to help them cope with the stress of having an untreated cancer.…”

Diagnosis of prostate cancer in one day: The benefits of cytology in tumour detection

“…Perhaps this is due to a perceived inactivity of active surveillance relative to traditional narratives of cancer treatment. Therefore, the authors suggest a need to improve diagnosis and treatment information provision particularly for lower risk patients 7 …”