Anxiety and AS: a patient’s perspective


In his most recent commentary on living on active surveillance, journalist Howard Wolinsky writes about the issue of anxiety which can affect a significant subset of men who are appropriate candidates for active surveillance (AS) or who have difficulty staying on AS — particularly during their first two years of management using this technique. Click here to see Howard’s article on the MedPage Today web site.

As those of us who have been monitoring progress in the use of AS over the past decade or so are well aware, some clinical practices seem to be better than others at understanding how to implement AS well over time and address this issue of anxiety. Specifically, Howard reports on a conversation he has had with Andrew Vickers, PhD, of the Memorial Sloan-Kettering Cancer Center on how they have been addressing this issue in a series of > 450 patients on AS over the past 18 or so years..

3 Responses

  1. I believe Peter Carroll’s cohort of around 900 men on AS at UCSF shows a significantly higher number who drop out from anxiety … around 30+%.

  2. I was on AS for 5 years before treatment and tolerated it well, and it has now been 3 years after treatment. I don’t find much difference in the stress level of waiting for PSA results now versus while I was on AS. There is uncertainty and a chance of getting bad news with both. I think it is just part of the new normal after a prostate cancer diagnosis that you never are completely rid of, and you learn to live with it and go on with your life. …

  3. Dear Mac:

    I think it is important to acknowledge and understand that while some men — like you and Howard Wolinksy — can cope very well (and relatively easily) with regular PSA testing (on active surveillance and afterwards), with a minimal level of stress, others have a far harder time with this, for all sorts of possible reasons.

    Prostate cancer and its management is rife with these levels of variation in how different men respond to everything from the shock of their initial diagnosis to the way their bodies react to androgen deprivation therapy (ADT).

    Some men simply need a lot more help with their anxiety than you. Luckily for you (and others), this doesn’t seem to be a big deal and you have been able to work out how to deal with the situation without such help.

    The men who do have higher levels of anxiety that affect their quality of life need to know that help is available, and that they should raise this with their healthcare providers. There is nothing “unmanly” about this. It is a well-understood biomedical reality.

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