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The association of cancer-specific anxiety with disease aggressiveness in men on active surveillance of prostate cancer

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  • Clinical Research
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Abstract

Background

Active surveillance (AS) provides appropriate prostate cancer (PCa)-specific survival while minimizing morbidity, but underlying worry of PCa can generate anxiety. The aim of the study is to evaluate anxiety levels in men on AS and how anxiety relates to disease characteristics and treatment decision-making.

Methods

A retrospective analysis was conducted using all 302 subjects from the Reduction by Dutasteride of clinical progression Events in Expectant Management (REDEEM) study. Prostate biopsies were obtained at 18 and 36 months. Anxiety was measured at baseline and 3, 6, 12, 18, and 36 months post-randomization using the MAX-PC (Memorial general anxiety scale for PCa) questionnaire. Univariable and multivariable analysis of the association of disease aggressiveness (PSA levels, percentage of positive cores, and maximum core involvement) and anxiety levels were performed. Cox regression was used to analyze time to progression to discontinuation of active surveillance as a function of baseline anxiety.

Results

Overall, MAX-PC scores decreased from moderate at baseline with slight increases after receiving PSA results at 18 months, followed by more decline. Percentage of positive cores was associated with baseline anxiety (P = 0.02). The association remained when controlling for age, race, number of cores sampled, body mass index, prostate volume, and maximum core length (P = 0.003). In univariable and multivariable analysis, baseline anxiety was not significantly associated with time to progression to discontinuation of active surveillance.

Conclusions

In evaluating the natural history of anxiety levels among patients with prostate cancer undergoing active surveillance, there was a decline of anxiety levels over time, with increases after receiving PSA results. Moreover, we found that disease aggressiveness measured by percentage of positive biopsy cores was associated with baseline levels of anxiety. However, anxiety had no impact on clinical or therapeutic progression.

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Fig. 1: Natural history of MAX-PC scores in men undergoing active surveillance for prostate cancer.
Fig. 2: Kaplan–Meier curve of progression of discontinuation of active surveillance by anxiety levels.

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Code availability

All computer code used to generate results is available upon request.

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Authors and Affiliations

  1. Department of Urology, University of Illinois College of Medicine, Chicago, IL, USA

    Ushasi Naha, Michael R. Abern & Daniel M. Moreira

  2. Division of Urology, Department of Surgery and the Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Stephen J. Freedland

  3. Urology Section, Veterans Affairs Medical Center, Durham, NC, USA

    Stephen J. Freedland

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  1. Ushasi Naha
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  2. Stephen J. Freedland
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  3. Michael R. Abern
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  4. Daniel M. Moreira
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Correspondence to Daniel M. Moreira.

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Naha, U., Freedland, S.J., Abern, M.R. et al. The association of cancer-specific anxiety with disease aggressiveness in men on active surveillance of prostate cancer. Prostate Cancer Prostatic Dis 24, 335–340 (2021). https://doi.org/10.1038/s41391-020-00279-z

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