How anxiety affects prostate cancer patients on active surveillance over time


“Anxiety” of different types is a problem associated with every diagnosis of prostate cancer. Such anxiety comes with particular implications for men implementing active surveillance as an initial management strategy after initial diagnosis with very low-, low-, or favorable intermediate-risk prostate cancer.

The unique aspect of anxiety associated with the decision to start by managing very low-, low-, or favorable intermediate-risk prostate cancer on active surveillance (as opposed to some form of immediate treatment) is based on the fear that one may not be taking appropriate action with curative intent at an early enough time. This is a perfectly reasonable and predictable form of anxiety. And clinicians who are used to managing patients on active surveillance are accustomed to helping their patients address such anxiety. However, …

We also know that a subset of men who start out on active surveillance will change to having invasive treatment with curative intent based solely on their anxiety level.

Results of a study by Marzouk et al. — to be presented at the upcoming annual meeting of the American Urological Association (AUA) next month — addresses the subject of prostate cancer-specific anxiety in a large cohort of men being managed on active surveillance at the Memorial Sloan-Kettering Cancer Center in New York between 2000 and 2016. The good news from this large study is that, for the majority of the patients, anxiety declined moderately but significantly over time.

While patients were on study they were asked to complete quality of life questionnaires routinely as a component of their clinical care. The quality of life questionnaires included specific questions that had been adapted from the so-called Memorial Anxiety Scale for Prostate Cancer — a scale that can be used to assess whether the diagnosis of prostate cancer is impacting a patient’s ability to plan for the future or is resulting in distressing worries or thoughts. They were also asked to rank their overall state of health on a validated 10-point scale.

So here are the most important findings of this study to date:

  • The study initially enrolled 463 participants who were initiated on active surveillance.
    • Average (median) patient age was 61 years.
    • Average (median) PSA at diagnosis was 4.4 ng/ml.
    • 95 percent of patients were diagnosed with Gleason 3 + 3 = 6 disease.
    • 29 percent of patients had a prior family history of prostate cancer.
    • 81 percent of patients were married.
  • 413/463 participants actually completed the relevant quality of life questionnaires.
  • Average (median) time from initiation of active surveillance to completion of the last survey was 3.7 years.
  • Risk for anxiety decreased with time on active surveillance (odds ratio [OR] = 0.87; p = 0.003; see Figure 1 in the abstract of the study report).
  • Patients with higher overall health scores had lower anxiety levels over time on active surveillance (OR = 0.83; p = 0.001).
  • Pathologic and demographic characteristics, including age and marital status, were not associated with change in cancer-related anxiety (after adjusting for time on active surveillance).

Marzouk et al. conclude that:

Men considering [active surveillance] can be informed that, although it is expected to sense an increase in anxiety early, most men adjust rapidly and report low levels of anxiety within 2 years.

2 Responses

  1. Great article, thanks for posting

  2. Survivor bias. … Perception bias (i.e. AS has become more widely accepted on a timescale of 2 years over the life of the study, and longer).

    The correlation between overall health and anxiety is fascinating. Needs a control group though.

    I am a case in point. The very next article (in the list of AUA abstracts) addresses my situation and concludes “AS appears to be a safe initial management strategy for carefully selected men with Grade Group 2 prostate cancer managed at a tertiary cancer center”, and I feel less anxious.

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