Pre-surgical stress management and radical prostatectomy

One’s attitude of mind is well known to affect one’s response to certain types of treatment for many different disorders. At the very simplest level, people with a “glass half full” mentality do have a tendency to recover better from their illnesses than those who see the glass as being “half empty.”

A new study by Cohen et al. has suggested that the use of stress management techniques prior to prostate cancer surgery may help to activate the body’s immune response leading to quicker recovery, as well as aid in lowering mood disturbance. But it seems difficult to The “New” Prostate Cancer InfoLink to draw any direct correlation between reduced stress pre-surgery and outcome post-surgery. It is quite certainly the case that plenty of men go into prostate cancer surgery with a positive attitude and come out the other end upset and with a sense of being deceived … for all sorts of reasons that have much more to do with expectation management than their stress levels. (We should note that this is the second of two papers based on a cohort of 159 patients all treated surgically at the same institution. The earlier paper was published by Parker et al. in 2009.)

High levels of stress are not unusual among men facing prostate cancer surgery — for very obvious reasons. We also know that the physical and psychological stress of surgery can significantly impact the immune system by causing inflammatory responses at the surgical site and elsewhere in the patient’s body.

In their study, Cohen et al. report data from a cohort of 159 patients, all of whom were scheduled for radical prostatectomy as first-line treatment for supposedly localized prostate cancer. They randomized their patients to one of three groups:

  • Group A: Patients who received a series of highly structured stress management interventions, including two meetings with a psychologist in the 2 weeks immediately prior to surgery.
  • Group B: Patients who received supportive attention, including meetings with a psychologist prior to surgery, but no highly structured set of stress management interventions
  • Group C: Patients who received standard medical care and had no meetings with psychologists

Blood samples were collected from each patient about a month before surgery and 48 hours after surgery. Patient mood was measured about a month before surgery, a week before surgery (after the interventions, where such interventions were given), and the morning of the surgery.

Here are the results at 2 days post-surgery:

  • Men in Group A had
    • Significantly higher levels of natural killer function and circulating pro-inflammatory cytokines than men in Group B
    • Higher levels of natural killer function and the cytokine IL-1b than men in Group C
    • Increased immune system parameters, which decreased or stayed the same for men in Groups B and C
  • Men in Group A also had lower mood disturbances before surgery than men in Groups B and C, but this was not associated with immune outcomes.

Additional details are available in a media release from the University of Texas M. D. Anderson Cancer Center.

Clearly there are men for whom stress management shortly before radical prostatectomy will help them to optimize the chances of a good recovery post-surgery. In other words, there is a short-term effect on biological measures of stress post-surgery. However, the real clinical impact of this effect needs to be measured over a significant time period and assessed against biological outcomes months and years after the original operation. In the earlier paper by Parker et al., the same group of authors were able to show that there were some, small long-term effects that appeared to be associated with patients receiving intensive stress management. However, since there was no attempt to stratify the patients prior to randomization based on their degree of stress, it would be hard to know to what extent such small (albeit statistically significant) improvements in outcome could really be attributed with confidence to the use of intensive stress management pre-surgery.

What’s the bottom line? Intensive stress management prior to surgery won’t hurt the patient scheduled for radical prostatectomy … but the extent to which it will really help is still a work in progress.

Note: Tara Parker-Pope has also commented on this paper on the New York Times “Well” blog.

One Response

  1. The word “stress” actually relates to wear and tear as when the rubber meets the road on a tire or the brake pads pressing up against the rotor in the wheel. The term as it applies to living organisms was first introduced by Hans Seyle in the 1930s who defined it as the consequence of the failure of an organism (human or animal) to respond appropriately to emotional or physical threats, whether actual or imagined. Thus stress symptoms are the manifestation of a chronic state of responses to stress triggers that are actually benign. Even a thought can set off the same response mechanism that would be in play while standing in front of a hungry lion. Hence, Seyle’s definition still reaches to the heart of stress management; the idea of the response being inappropriate and engaging in a process of altering one’s misperception of pending disaster or imminent danger.

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