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Anxiety in the management of localised prostate cancer by active surveillance

Publication: BJU Int. 114 Suppl 1:55-61, November 2014


To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health-related quality of life (HRQL).

Patients and methods:
In all, 260 men with prostate cancer on AS were invited to complete psychological measures including the Hospital and Anxiety Depression Scale; the State-Trait Anxiety Inventory-Trait Scale; the Memorial Anxiety Scale for Prostate Cancer; and the Functional Assessment of Cancer Therapy Scale-Prostate. Overall, 86 men with a mean (sd, range) age of 65.7 (5.4, 51-75) years returned data, yielding a response rate of 33%. Outcome measures were standardised psychological measures. Pearson’s correlations were used to examine bivariate relationships, while regression analyses were used to describe predictors of dependent variables.

When compared with the findings of prior research, the men in our cohort had normal levels of general anxiety and illness-specific anxiety and high prostate cancer-related HRQL. Age, trait anxiety and fear of recurrence (FoR) were significant predictors of prostate cancer-related HRQL; trait anxiety and FoR were significant predictors of total HRQL. Results should be interpreted in context of sample characteristics and the correlational design of the study.

Participants reported low levels of anxiety and high HRQL. Trait anxiety and FoR were significant predictors of both prostate cancer-related and total HRQL. The administration of a short trait-anxiety screening tool may help identify men with clinically significant levels of anxiety and those at risk of reduced HRQL.

Commented by Henk van der Poel

Anxiety levels in men on active surveillance for low risk prostate cancer were low. In this study response rate was disturbingly low (33%), but of the men that did show a QOL rsponse, it was high. It remains unclear whether the majority of men did not response because of disinterest or anxiety. It would be interesting to assess anxiety in those men that will experience progression and secondary need for local treatment.