Abstract
Purpose
Knowledge of the psychological distress of long- and very long-term (>10 years) prostate cancer (PC) survivors is limited. This study intended to examine the parameters influencing anxiety related to prostate-specific antigen (PSA) and PC in long-term survivors after radical prostatectomy.
Methods
We surveyed 4719 PC survivors from the German multicenter prospective database “Familial Prostate Cancer.” We evaluated the association of PC-related anxiety (MAX-PC) with sociodemographic characteristics, family history of PC, global health status/quality of life (EORTC QLQ-C30), depression and anxiety (PHQ-2; GAD-2), latest PSA level, time since radical prostatectomy, and current therapy.
Results
The survey participants’ mean age was 75.2 years (SD = 6.5). Median follow-up was 11.5 years, and 19.5% of participants had survived more than 15 years since the initial treatment. The final regression analysis found that younger age, lower global health status/quality of life, higher depression and anxiety scores, higher latest PSA level, and shorter time since radical prostatectomy predicted increased PSA-related anxiety and PC anxiety. Familial PC was predictive only of PSA anxiety (all p < 0.05). The final model explained 12% of the variance for PSA anxiety and 24% for PC anxiety.
Conclusions
PC-related anxiety remained relevant many years after prostatectomy and was influenced by younger age, psychological status, rising PSA level, and shorter time since initial treatment.
Implications for Cancer Survivors
Survivors with these characteristics are at increased risk of PC-related anxieties, which should be considered by the treating physician during follow-up.
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References
Zhou CK, Check DP, Lortet-Tieulent J, et al. Prostate cancer incidence in 43 populations worldwide: an analysis of time trends overall and by age group. Int J Cancer. 2016;138:1388–400.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2016;66:7–30.
Robert Koch Institut. Krebs in Deutschland 2011/2012 [Cancer in Germany 2011/2012]. 10. Edition, 2015. http://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/kid_2015/krebs_in_deutschland_2015.pdf?__blob=publicationFile. Accessed 25 Nov 2016.
Steinberg GD, Carter BS, Beaty TH, et al. Family history and the risk of prostate cancer. Prostate. 1990;17:337–47.
Powell IJ, Meyskens FL. African American men and hereditary/familial prostate cancer: intermediate-risk populations for chemoprevention trials. Urology. 2001;57:178–81.
National Cancer Institute. Surveillance, Epidemiology, and End Results Program. SEER stat fact sheets: prostate cancer. 2015. http://seer.cancer.gov/statfacts/html/prost.html. Accessed 25 Nov 2016.
Budäus L, Spethmann J, Isbarn H, et al. Inverse stage migration in patients undergoing radical prostatectomy: results of 8916 European patients treated within the last decade. BJU Int. 2011;108:1256–61.
World Health Organization. Life expectancy data by country. 2015. http://apps.who.int/gho/data/node.main.688. Accessed 25 Nov 2016.
Lassemillante AC, Doi SA, Hooper JD, et al. Prevalence of osteoporosis in prostate cancer survivors: a meta-analysis. Endocrine. 2014;45:370–81.
Hyde MK, Zajdlewicz L, Wootten AC, et al. Medical help-seeking for sexual concerns in prostate cancer survivors. Sex Med. 2016;4:e7–e17.
Olsson CE, Alsadius D, Pettersson N, et al. Patient-reported sexual toxicity after radiation therapy in long-term prostate cancer survivors. Br J Cancer. 2015;113:802–8.
Kopp RP, Marshall LM, Wang PY, et al. The burden of urinary incontinence and urinary bother among elderly prostate cancer survivors. Eur Urol. 2013;64:672–9.
Gavin AT, Drummond JF, Donnelly C, et al. Patient-reported ‘ever had’ and ‘current’ long-term physical symptoms after prostate cancer treatments. BJU Int. 2015;116:397–406.
Darwish-Yassine M, Berenji M, Wing D, et al. Evaluating long-term patient-centered outcomes following prostate cancer treatment: findings from the Michigan Prostate Cancer Survivor study. J Cancer Surviv. 2014;8:121–30.
van de Wal M, van Oort I, Schouten J, et al. Fear of cancer recurrence in prostate cancer survivors. Acta Oncol. 2016;55:821–7.
Dahl S, Cvancarova M, Dahl AA, et al. Work ability in prostate cancer survivors after radical prostatectomy. Scand J Urol. 2016;50:116–22.
Morris BB, Farnan L, Song L, et al. Treatment decisional regret among men with prostate cancer: racial differences and influential factors in the North Carolina Health Access and Prostate Cancer Treatment Project (HCaP-NC). Cancer. 2015;121:2029–35.
Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nat Rev Cancer. 2008;8:268–78.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer. 2016. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 25 Nov 2016.
European Association of Urology. Guidelines on prostate cancer. 2016. https://uroweb.org/guideline/prostate-cancer/. Accessed 25 Nov 2016.
Shen MJ, Nelson CJ, Peters E, et al. Decision-making processes among prostate cancer survivors with rising PSA levels: results from a qualitative analysis. Med Decis Mak. 2015;35:477–86.
Dale W, Bilir P, Han M, et al. The role of anxiety in prostate carcinoma. Cancer. 2005;104:467–78.
Klotz LH. PSAdynia and other PSA-related syndromes: a new epidemic—a case history and taxonomy. Urology. 1997;50:831–2.
Punnen S, Cowan JE, Chan JM, et al. Long-term health-related quality of life after primary treatment for localized prostate cancer: results from the CaPSURE registry. Eur Urol. 2015;68:600–8.
Watts S, Leydon G, Birch B, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4:e003901.
Sharp L, O’Leary E, Kinnear H, et al. Cancer-related symptoms predict psychological wellbeing among prostate cancer survivors: results from the PiCTure study. Psycho-Oncology. 2016;25:282–91.
Dinkel A, Kornmayer M, Gschwend JE, et al. Influence of family history on psychosocial distress and perceived need for treatment in prostate cancer survivors. Familial Cancer. 2014;13:481–8.
Tavlarides AM, Ames SC, Diehl NN, et al. Evaluation of the association of prostate cancer-specific anxiety with sexual function, depression and cancer aggressiveness in men 1 year following surgical treatment for localized prostate cancer. Psycho-Oncology. 2013;22:1328–35.
Roth A, Nelson CJ, Rosenfeld B, et al. Assessing anxiety in men with prostate cancer: further data on the reliability and validity of the Memorial Anxiety Scale for Prostate Cancer (MAX–PC). Psychosomatics. 2006;47:340–7.
Roth AJ, Rosenfeld B, Kornblith AB, et al. The Memorial Anxiety Scale for Prostate Cancer. Validation of a new scale to measure anxiety in men with prosate cancer. Cancer. 2003;97:2910–8.
Venderbos LD, van den Bergh RC, Roobol MJ, et al. A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels. Psycho-Oncology. 2015;24:348–54.
Tan HJ, Marks LS, Hoyt MA, et al. The relationship between intolerance of uncertainty and anxiety in men on active surveillance for prostate cancer. J Urol. 2016;195:1724–30.
Tavlarides AM, Ames SC, Thiel DD, et al. Baseline and follow-up association of the MAX-PC in men with newly diagnosed prostate cancer. Psycho-Oncology. 2015;24:451–7.
Heck MM, Kron M, Gschwend JE, et al. Effect of family history on outcome in German patients treated with radical prostatectomy for clinically localised prostate cancer. Eur J Cancer. 2012;48:1312–7.
Lehmann C, Mehnert A, Schulte T, et al. Erfassung krebs-und behandlungsspezifischer Ängste bei Prostatakrebspatienten in der Rehabilitation: Der Memorial Angst-Fragebogen für Prostatakrebs (MAX-PC). Praxis Klinische Verhaltensmedizin und Rehabilitation. 2006;19:345–52.
Mehnert A, Lehmann C, Schulte T, et al. Presence of symptom distress and prostate cancer-related anxiety in patients at the beginning of cancer rehabilitation. Onkologie. 2007;30:551–6.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.
Kroenke K, Spitzer RL, Williams JB, et al. An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics. 2009;50:613–21.
Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122:86–95.
Lamers RE, Cuypers M, Husson O, et al. Patients are dissatisfied with information provision: perceived information provision and quality of life in prostate cancer patients. Psycho-Oncology. 2016;25:633–40.
Violan C, Foguet-Boreu Q, Flores-Mateo G, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS One. 2014;9:e102149.
Vissers PA, Thong MS, Pouwer F, et al. The impact of comorbidity on health-related quality of life among cancer survivors: analyses of data from the PROFILES registry. J Cancer Surviv. 2013;7:602–13.
Drummond FJ, Kinnear H, O’Leary E, et al. Long-term health-related quality of life of prostate cancer survivors vary by primary treatment. Results from the PiCTure (Prostate Cancer Treatment, your experience) study. J Cancer Surviv. 2015;9:361–72.
Banks E, Byles JE, Gibson RE, et al. Is psychological distress in people living with cancer related to the fact of diagnosis, current treatment or level of disability? Findings from a large Australian study. Med J Aust. 2010;193(5 Suppl):S62–7.
Roth A, Passik S. Anxiety in men with prostate cancer may interfere with effective management of the disease. Primary Care Cancer. 1996;16:30.
Lofters A, Juffs HG, Pond GR, et al. “PSA-itis”: knowledge of serum prostate specific antigen and other causes of anxiety in men with metastatic prostate cancer. J Urol. 2002;168:2516–20.
Hillen MA, de Haes HC, Smets EM. Cancer patients’ trust in their physician—a review. Psycho-Oncology. 2011;20:227–41.
Albright F, Stephenson RA, Agarwal N, et al. Prostate cancer risk prediction based on complete prostate cancer family history. Prostate. 2015;75:390–8.
Spencer BA, Babey SH, Etzioni DA, et al. A population-based survey of prostate-specific antigen testing among California men at higher risk for prostate carcinoma. Cancer. 2006;106:765–74.
Meiser B, Cowan R, Costello A, et al. Prostate cancer screening in men with a family history of prostate cancer: the role of partners in influencing men’s screening uptake. Urology. 2007;70:738–42.
Cohen L, Fouladi RT, Babaian RJ, et al. Cancer worry is associated with abnormal prostate-specific antigen levels in men participating in a community screening program. Cancer Epidemiol Biomark Prev. 2003;12:610–7.
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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Meissner, V.H., Herkommer, K., Marten-Mittag, B. et al. Prostate cancer-related anxiety in long-term survivors after radical prostatectomy. J Cancer Surviv 11, 800–807 (2017). https://doi.org/10.1007/s11764-017-0619-y
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DOI: https://doi.org/10.1007/s11764-017-0619-y