Prospective analysis of psychological distress in men being investigated for prostate cancer

Abstract

ObjectivesTo determine the level and prevalence of anxiety and depression in men being investigated for prostate cancer (CaP) and also to identify those aspects of the diagnostic pathway that induces the most stress.MATERIALS AND METHODSAll patients undergoing transrectal ultrasound-guided biopsy (TRUS-B) of the prostate for suspected CaP at our institute between June 2008 and April 2009 were enrolled in this prospective study. All patients completed two questionnaires, prior to their biopsy (HADS1) and before receiving results (HADS2), containing the Hospital Anxiety and Depression Scale (HADS). The data were analyzed and the differences in HADS were compared.ResultsA total of 112 men were included in the trial. Two patients could not complete the second part of HADS (HADS2) and were excluded from the study. Prevalence of anxiety among the 110 patients was 43/110 (39.1%). Mean score for anxiety in these 43 patients before biopsy (HADS A1) was 10.74 and score just before receiving the biopsy report (HADS A2) was 11.55. Prevalence of depression before TRUSB (HADS D1) was 21/110 (19.1%) with a mean score of 10.59. Prevalence of depression while awaiting the biopsy report (HADS D2) was 22/110 (20%) with mean score of 10.62.ConclusionThere was a high prevalence of anxiety and depression in our study population and waiting for biopsy results was the most stressful event. Questionnaires such as HADS can identify patients with psychological distress. Minimizing the stress while waiting for a diagnosis should help optimize patient care.

Psychological stress assessment of patients suffering from prostate cancer

“…It may be assumed that uncertainty throughout the waiting time is more relevant with regard to psychological distress than the positive histology by the diagnosis of PC. This is in agreement with several studies concluding that the moment immediately before being informed about the histological result of a PB, regardless of whether it is benign or malignant, is associated with more distress than the diagnostic process itself [3][4][5][6]22]. These findings have been assessed with questionnaires [3][4][5][6] as well as with serum cortisol levels, assuming that they correlate with the grade of emotional distress [22].…”

“…While elevated PSA levels alone do not lead to an increase in anxiety and depression compared to the general population [8], the question of whether a PB may influence anxiety and depression has been discussed, with conflicting results: Awsare et al [5] found a low level of anxiety (4-7%) and depression (1.4%), whereas Jadhav et al [3] reported a high rate of anxiety before PB (39%) and a prevalence of depression of 20%. Macefield et al [4] noted a significant increase in psychological distress, tense and anxious moods from PSA testing until biopsy, with about 20% of men reporting high levels of psychological disorders at the time of biopsy.…”

“…These studies assessed the psychological stress (in particular anxiety and depression) of PC screening in the absence of cancer [3][4][5][6][7][8]. Psychological distress may be caused not only by anxiety and depression, but also by concerns about erectile dysfunction (ED) and urinary incontinence following RP, as well as effects on the patient's partnership.…”

Effect of patient position on pain scales during transrectal ultrasound-guided prostate biopsy

“…In addition, we hypothesized that the lithotomy position may be more acceptable than the LLD position regarding communication between patients and physicians. Some studies have reported that pain perception during prostate biopsy was related to the level of anxiety [ 19 , 20 ]. Bruyere et al [ 11 ] published a study comparing the pain experienced during prostate biopsy in two different positions: lithotomy and LLD.…”

Development and Validation of a Disease-Specific Scale to Assess Psychosocial Well-Being of Patients Living With Unruptured Intracranial Aneurysm

“…Patients screening positive for prostate cancer have been shown to endure considerable psychological distress while undergoing the examination process (Jadhav, Sukumar, Kumar, & Bhat, 2010), and those who chose nonintervention tended to have lower physical and psychological scores on quality of life (QOL) measurement, Short Form 36, compared with those who underwent treatment (Chou et al, 2011). However, an individual diagnosed with a UIA may have to undergo periodic follow-ups, agonizing for the rest of their lives over the possibility of a rupture and struggling with decision-making conflicts with regard to different treatment options.…”