Anxiety in men undergoing active surveillance for prostate cancer tapers over time
Men undergoing active surveillance for prostate cancer exhibit moderate risk of cancer-specific mortality, which significantly declines over time, a recent study reports.
Researchers used a modified version of the Memorial Anxiety Scale for Prostate Cancer to evaluate cancer-specific anxiety in 413 men (median age 61 years) undergoing active surveillance at a single tertiary care centre. Median prostate-specific antigen at baseline was 4.4 ng/mL.
Participants completed a median of two surveys each. The time from surveillance initiation to the first and last survey was 2.8 and 3.7 years, respectively. Majority of participants had grade 1 disease at the beginning of surveillance.
During the first year of surveillance, an estimated 29 percent of the men were at risk of prostate cancer-related anxiety. This declined to 14 percent after 7.5 years, the rate of which reached significance (odds ratio [OR], 0.87 per year; 95 percent CI, 0.79–0.95; p=0.003).
“There was a possible explanation of these findings. If anxious patients gradually quit active surveillance due to anxiety, anxiety levels would appear to fall with an increasing duration of time on surveillance,” researchers offered.
However, upon analysis of the reasons for discontinuation, they found that only 2–3 percent of the total cohort switched to treatment for personal reasons. This therefore did not account for the 15-percent absolute decrease in the risk of anxiety over time.
Multivariable generalized estimating equation models adjusted for active surveillance time showed that men who reported a better overall state of health were significantly less likely to be at risk of anxiety (OR, 0.83; 0.74–0.93; p=0.001).