SUO 2017: Prostate Cancer Anxiety in Men Undergoing Active Surveillance

Washington, DC ( Active surveillance is now the established treatment of choice for men with low-risk, low-volume prostate cancer. However, as the number of men on AS increases, it is also understood that a significant portion of men who go on to definitive therapy are a result of patient choice – decision to get definitive therapy without evidence of progression. With so many men on a surveillance protocol for many years, there is potentially some component of anxiety that can drive decision making.

In this analysis, the authors use prospective data from a large institutional cohort of men on AS to address the issue of anxiety. Of 463 patients enrolled in AS from March 2000 through January 2016, 413 had completed a prostate cancer (PCa) quality of life survey as part of routine clinical care. Men were asked if PCa impaired their ability to plan for the future, if PCa resulted in distressing worries or thoughts, and if these thoughts have affected their mood. Men were also asked to rank their overall state of health on a 10-point Likert scale. 

The median age of men on AS was 61 years with a median PSA at diagnosis 4.4 ng/ml; 95% of patients had Gleason 6 disease, 29% had a family history, and 81% were married. The median time from AS initiation to last survey was 3.7 years, which provides good longer term data for patients on AS for > 1 year. The risk of anxiety decreased with time on AS (OR=0.87; 95% CI: 0.79, 0.95; p=0.003). 
prostate anxiety fig1

Patients reporting higher overall health scores had lower anxiety levels which lasted throughout the duration on AS (95% CI: 0.74, 0.93; p=0.001). None of the other covariates of interest were significantly associated with the change in the risk of high anxiety after adjusting for time.

Based on this, the authors conclude that although moderate levels of anxiety exist in men undergoing AS, it significantly decreases over time. This data is reassuring that most men do quite well with AS.

Presented by:  Karim Marzouk, MD, FRCSC

Co-Authors: Behfar Ehdaie MD, MPH², Melissa Assel MS³ and Andrew Vickers PhD³

Affiliation: ¹Memorial Sloan Kettering Cancer Center, Department of Surgery, Division of Urology, New York, NY; ²Memorial Sloan Kettering Cancer Center, Department of Surgery, Division of Urology; ³Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC
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