Investigating the Psychological Impact of Active Surveillance or Active Treatment in Newly Diagnosed Favorable-Risk Prostate Cancer Patients: A 9 month Longitudinal Study.

Abstract

Objective This study aimed to explorethe psychological impact of favorable-risk prostate cancer (PCa) and associated treatment (Active Surveillance (AS) or Active Treatment (AT)), comparing prevalence and temporal variability of generalized anxiety, PCa-specific anxiety, and depression symptoms. Methods PCa patients were recruited at diagnosis prior to treatment decision-making and completed questionnaires assessing anxiety (STAI-6; MAX-PC) and depression symptoms (CES-D) at four timepoints for 9-months. Non-cancer controls were recruited via university staff lists and community groups. Results were analyzed using analysis of variance. Results Fifty-four PCa (AS n=11, AT n=43) and fifty-three non-cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES-D scores (p>0.05). The main effect of treatment on STAI-6 scores was significant (F(2,73)=4.678, p=0.012) with AS patients reporting highest STAI-6 scores (T1 M=36.56; T2 M=36.89, T3 M=38.46; T4 M=38.89). There was a significant main effect for time since diagnosis on MAX-PC (F(3,123)=3.68, p=0.01), AS patient scored higher than AT at all timepoints (T1 M=10.33 v 10.78; T2 M=11.11 v 11.30; T3 M=13.44 v 10.55; T4 M=11.33 v 8.88), however both groups declined overall with time. Conclusions Men undergoing AS had significantly higher anxiety symptoms than AT and non-cancer participants, contradicting previous literature. This may be due to perceived inactivity of AS relative to traditional narratives of cancer treatment. Participant experiences appear to be less favorable relative to other international centers. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision particularly for lower-risk patients.