Waiting on prostate treatment not distressing for most

NEW YORK (Reuters Health) - "Watchful waiting" for disease progression won't make men with slow-growing prostate cancer more anxious or distressed, especially if they're in relatively good health otherwise and not too anxious to begin with, new research shows.

With watchful waiting, also called active surveillance, patients with early low-risk prostate tumors are monitored regularly and only treated if their cancer progresses. Watchful waiting aims to delay or avoid the side effects of radical treatment, such as surgery or radiation. Nevertheless, concerns have been raised that not undergoing active treatment could cause anxiety and distress in these patients.

To investigate, Dr. Roderick C. N. van den Bergh of Erasmus Medical Center in Rotterdam, The Netherlands, and colleagues looked at 129 men with slow-growing prostate cancers who opted for active surveillance over other types of treatment.

At about two months after their prostate cancer diagnosis and again nine months after diagnosis, the men underwent a battery of tests to measure their anxiety levels, fears of cancer progression, depressive symptoms, and other psychological and personality factors.

Just two of the men stopped active surveillance for non-medical reasons during the course of the study. The main factor that predicted a man's level of anxiety at the second time point was how anxious he was at the study's outset.

Men who had neurotic personalities -- meaning they showed excessive worry and anxiety over normal life events -- were more likely to be anxious, as were those who felt their physicians had an important role in how their prostate cancer would be treated. Older men and those in good physical health were less anxious and distressed.

In a commentary published with the study, Dr. Jeremy Couper of the Peter Mac Callum Cancer Center in Melbourne, Victoria, Australia, notes that in his own study of the psychological effects of various types of prostate cancer treatment, men who chose hormone therapy had worse mental health and quality of life than those who chose other options.

The new findings are "another piece in the jigsaw as we learn how best to advise patients diagnosed with potentially curable prostate cancer," Couper concluded.

SOURCE: The Journal of Urology, May 2010.