Emotional distress may motivate men with low-risk prostate cancer to choose a more aggressive treatment, such as surgery or radiation therapy, instead of active surveillance, researchers at the University at Buffalo and Roswell Park Cancer Institute report.
Addressing such distress and the fears behind it before and during treatment may ease their reluctance to active surveillance (where the cancer is only carefully monitored for signs of progression), the team said.
The study, “Emotional Distress Increases the Likelihood of Undergoing Surgery among Men with Localized Prostate Cancer,” was published in the Journal of Urology.
Being diagnosed with prostate cancer, like any cancer, can affect people psychologically. Depression, anxiety, stress, fatigue, and pain are commonly reported in these patients. The sexual problems and incontinence that are often experienced by prostate cancer patients complicate matters further.
Findings support “what we have been pushing a long time for, which is, ‘Let’s make this decision as informed and supported as possible,'” Heather Orom, PhD, associate professor of community health and health behavior in UB’s School of Public Health and Health Professions, said in news release. “If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety.”
Orum and colleagues examined emotional distress and treatment decisions in 1,531 patients men with newly diagnosed, localized prostate cancer. Of these, 36 percent had low-risk disease, 49 percent had intermediate risk, and 15 percent were high risk.
In terms of treatment, 24 percent of the men opted for active surveillance, while 27 percent chose radiation and 48 percent decided to undergo surgery. Emotional health was measured with the Distress Thermometer, which scales anxiety from 0 (no distress) to 10 (extreme distress). Participants were assessed after their diagnosis and again as soon as they had made their treatment decision.
Men registering more distress at time of diagnosis were more likely to choose surgery over active surveillance. Those distressed when deciding on treatment usually opted for surgery over active surveillance or over radiation, choices that depended on their particular cancer and proposed treatment plan.
“Men’s level of emotional distress shortly after diagnosis predicted greater likelihood of choosing surgery over active surveillance,” the researchers report. “Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided.”
Surgery and radiation remains a concern for low-risk patients, because of possible side effects.
“There’s an interest in driving the decision-making experience to prevent overtreatment and ensure that men have full information about all the side effects so they can make a choice that’s preference and value driven,” Orom said. “We don’t want men to make a decision that they’ll regret later on.”