Active Surveillance Versus Curative Treatment for Prostate Cancer: No Difference in Patient Anxiety, Depression Rates

By Cecilia Brown - August 1, 2022

Patients with prostate cancer who were on active surveillance did not report significantly more anxiety or depressive symptoms than patients who received curative treatments, according to a recent study.
The results of the study, led by Davidson Sypre, MD, of the Institut Paoli-Calmettes, were published in Scientific Reports.

The study included 292 patients who had localized prostate cancer at T1–T2 stage with a Gleason score ≤7 who were on active surveillance (n = 67), received radical prostatectomy (n = 168), or were treated with radiotherapy (n = 57). Patients with recurrence requiring salvage therapy and patients who received more than six months of concomitant or sequential hormone therapy were excluded from the study.

The patients were a subset of participants in the French VICAN5 survey, which collected data from cancer survivors five years after their diagnosis. Participants self-reported information through telephone interviews.

Anxiety in Patients With Prostate Cancer

The proportion of patients with anxiety did not significantly differ by treatment type. Anxiety was reported in 34.3% of patients who were on active surveillance, in 28.6% of patients who received radical prostatectomy, and in 31.6% of patients who were treated with radiotherapy (P=.400). Anxiolytic use did not vary significantly among the three groups (P=.330).

Depressive Symptoms in Patients With Prostate Cancer

Depressive symptoms were not significantly different among groups. They were reported in 14.9% of patients who were on active surveillance, 10.7% of patients who received radical prostatectomy, and 22.8% of patients who were treated with radiotherapy (P=.770).

Factors Associated With Anxiety and Depression

Depression and anxiety were significantly associated with decreased mental health-related quality of life (P<.001 and P<.001, respectively). Depression and anxiety were also significantly associated with decreased physical health-related quality of life (P<.001 and P=.017, respectively) and reported fatigue (P<.001 and P<.001, respectively).

Financial situations “perceived as critical or difficult” were significantly associated with depressive symptoms (P=.002) and anxiety (P=.044), the authors reported.

Limitations

The study’s limitations included the lack of standardization in the active surveillance protocol across patients, the use of self-reported data, as well as unequal distribution and lack of randomization in groups. There also may have been a nonresponse bias for patients who had symptoms of depression or anxiety, the authors reported.

Implications

The risk of anxiety and depression in patients with prostate cancer who are treated with active surveillance as opposed to curative strategies has been “controversial,” the study’s authors wrote.

However, the results of this study showed no significant difference in anxiety or depression between patients on active surveillance and patients receiving curative treatment, “encouraging the extended use of [active surveillance] for patients with low-risk localized prostate cancer,” investigators concluded.

Reference

Impact of active surveillance for prostate cancer on the risk of depression and anxiety.

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