The effect of anxiety and uncertainty on men under prostate cancer active surveillance

The authors aimed to determine how anxiety and uncertainty affects men with prostate cancer who are undergoing active surveillance. 

The authors concluded that uncertainty and urinary complications promote anxiety in men on active surveillance for prostate cancer. They also recommend patient education and management of urinary problems to lessen this anxiety and promote active surveillance as a treatment option. 

In many men diagnosed with prostate cancer, cancer can progress slowly. In these cases active treatments may cause more harm than good in terms of side-effects experienced. Active surveillance is a management option in men diagnosed with localized (confined to the prostate gland), low-risk prostate cancer. It involves monitoring the cancer for any signs of progression without giving active treatment. The cancer is monitored by biopsies (taking tissue from the cancer site) and/or by measuring prostate specific antigen levels (PSA). PSA is a protein elevated in the blood when prostate cancer is present.

As no active treatment is given during active surveillance, patients may experience anxiety or intolerance of uncertainty (tendency to perceive uncertainty as threatening) due to the underlying threat of the cancer. The connection between active surveillance, uncertainty, and anxiety is still being explored.

The aim of this study was to determine whether anxiety was higher in men with greater intolerance for uncertainty undergoing active surveillance. 

119 men with low-risk cancer (confined to the prostate, low PSA levels, small tumor size) were used in this study. The average follow-up was 12 months. Each patient was asked to fill out surveys used to determine their mental attitude toward active surveillance. 

15.1% experienced general anxiety. 14.3% experienced anxiety specifically caused by prostate cancer. Men with increased depressive symptoms, moderate to severe urinary problems or men who had a family history of prostate cancer were more likely to experience general anxiety. Men who had moderate to severe urinary problems were more likely to experience prostate cancer-related anxiety. Intolerance of uncertainty was significantly associated with general and prostate cancer-specific anxiety.

Patients with greater uncertainty and moderate/severe urinary problems had greater odds of experiencing anxiety. This was compared to patients with mild urinary problems and lower levels of uncertainty. 

The authors concluded that uncertainty and urinary complications promote anxiety in men on active surveillance for prostate cancer. They also recommend patient education and management of urinary problems to lessen this anxiety and promote active surveillance as a treatment option.