Abstract
BackgroundThe psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significant levels of anxiety after diagnosis. The present study aimed to investigate if demographic, clinical, and psychological variables at the entrance in AS (T0) were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy (T1) and to offer psychological support to improve quality of life (QoL).Materials and MethodsA total of 236 patients participated in the PCa Research International: AS (PRIAS) protocol and in PRIAS-QoL study. Demographic/clinical features, health-related QoL domains, coping with cancer, PCa-related anxiety [Memorial Anxiety Scale for PCa (MAX-PC)], personality traits, and decision-making-related factors were assessed at T0. MAX-PC was also administered at T1. PCa-related anxiety at T1 was considered to be of clinical significance if the MAX-PC score was ≥1.5. Multivariable logistic regression coupled to bootstrap was used to detect factors associated with high levels of anxiety.ResultsThe median age was 64.4 years. Fifty-six patients (24%) reported MAX-PC total score above the cutoff. Three factors were associated with a high level of PCa anxiety at T1: anxious preoccupation [odds ratio (OR) = 4.36], extraversion (OR = 1.9), and prostate-related symptoms (median OR = 0.46). Physical well-being was associated with a low PCa anxiety subscale (median OR = 0.15); neuroticism and functional well-being were associated with PSA anxiety (median OR = 7.05 and 0.73, respectively). Neuroticism and helplessness/hopelessness were associated with fear of progression (median OR = 18.1 and 5.8, respectively).ConclusionOnly a partial portion of the sample experienced significant levels of anxiety after 10 months. Psychological assessment should be routinely conducted to detect risk factors (i.e., anxious preoccupation, extraversion) for increased anxiety, offering tailored psychological interventions aimed at promoting interpersonal awareness and emotional well-being.
Highlights
Active surveillance (AS) is increasingly considered a viable alternative to radical treatment for men with a diagnosis of very low/low-risk prostate cancer (PCa)
It was designed as single-center ancillary research to the multicenter prospective observational “PCa Research International: AS (PRIAS) study” (Bokhorst et al, 2016), in which selected men with low-risk PCa are managed based on a standardized protocol
Variable selection was based on least absolute shrinkage and selection operator (LASSO) (O’Connor, 1995); missing values were imputed through flexible multiple imputations using bootstrapping (O’Connor, 1995)
Summary
Active surveillance (AS) is increasingly considered a viable alternative to radical treatment (i.e., radical prostatectomy, external beam radiotherapy, or brachytherapy) for men with a diagnosis of very low/low-risk prostate cancer (PCa). There is a minority of patients who reported significant levels of anxiety after diagnosis, for example, in the run-up to clinical exams (i.e., re-biopsy, PSA test, and medical examination) (Anderson et al, 2014; Venderbos et al, 2015; Bokhorst et al, 2016; Parker et al, 2016) Those men showed a significant decrease of anxiety over time, which may suggest a relevant impact of coping strategies during the first period on AS (Marzouk et al, 2018; Dordoni et al, 2020). The psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. The present study aimed to investigate if demographic, clinical, and psychological variables at the entrance in AS (T0) were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy (T1) and to offer psychological support to improve quality of life (QoL)
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