Men diagnosed with prostate cancer may become distressed and consequently choose unnecessarily aggressive treatment options, according to a new study published in the Journal of Oncology.
Prostate cancer is a highly treatable form of cancer. There are an estimated 3 million prostate cancer survivors alive today in the US. However, overtreatment is a concern and can lead to adverse effects. Surgery and radiation therapy have side effects such as erectile dysfunction and incontinence. For the majority of men diagnosed with low-risk prostate cancer, these side effects can be avoided by choosing active surveillance to monitor the cancer and by considering treatment only if the disease progresses.
A study conducted by researchers from the University at Buffalo and Roswell Park Center Institute analyzed the emotional state of men newly diagnosed with clinically localized prostate cancer to see if distress levels were tied to the likelihood of undergoing surgery. Researchers sampled 1531 patients with either low- or intermediate-risk cancer and measured their emotional distress with the Distress Thermometer, an 11-point scale ranging for 0 (no distress) to 11 (extreme distress), after initial diagnosis and again after they made their treatment decisions.
Results of the study showed that patients who were more emotionally distressed at diagnosis were more likely to choose surgery over active surveillance (RRR, 1.07; 95% CI, 1.01, 1.14; P = .02). Patients who were more distressed at the time they made a treatment decision were also more likely to choose surgery over active surveillance (RRR, 1.16; 95% CI, 1.09, 1.24; P < .001).
Researchers concluded that emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment than necessary. For men with low-risk prostate cancer, researchers report, “Active surveillance may be a clinically viable option and side effects of surgery might be avoided.”
Physicians can address emotional distress before and during treatment decision-making to reduce barriers to choosing active surveillance. “It is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotional distress to prevent men from receiving a treatment that they don’t need or will later regret,” said Willie Underwood III, MD, MS, MPH, Department of Urology, University at Buffalo.
