Latini D et al. (2007) The relationship between anxiety and time to treatment for patients with prostate cancer on surveillance. J Urol 178: 826–832

Men diagnosed with localized prostate cancer have a range of treatment options; many older patients with low risk disease choose to opt for surveillance. The factors that affect the decision to move from surveillance to treatment are not well known. Latini and colleagues investigated the impact of patient anxiety on the decision to initiate treatment for prostate cancer patients on surveillance.

Patients with biopsy-proven prostate cancer, who selected surveillance rather than treatment, were drawn from the CAPSURE study. A total of 105 patients were eligible for inclusion. A 3-item scale was used to measure cancer anxiety. The authors calculated the change in PSA with time, as this often guides the decision to move from surveillance to treatment.

Men who sought treatment had higher PSA velocities than men who did not. These men also had larger differences in the anxiety change rate (P <0.01), suggesting that the patient's anxiety may be linked to his increasing PSA. Statistical analysis revealed that change in anxiety and PSA velocity were independent predictors for treatment initiation (P <0.01). Patients with higher PSA velocities were significantly more likely to receive treatment than patients with lower PSA velocities (hazard ratio 3.18, 95% CI 1.122–9.016).

The authors conclude that cancer-related anxiety can influence decisions regarding treatment for some patients with prostate cancer. Psychosocial support for these patients could delay treatment; further studies are needed to confirm this.