Prostate cancer anxiety may affect therapy choices

Among men who have been treated for prostate cancer, those who are particularly anxious after signs of a recurrence may not make the best decision about the next step in treatment, new research shows.

Specifically, older prostate cancer patients who have a high level of anxiety when their PSA levels starts rising are likely to opt quickly for androgen deprivation therapy (ADT) before it's necessary.

This finding is important since early ADT - which aims to eliminate testosterone that drives cancer growth - may not improve survival but could have a negative effect on quality of life, Dr. William Dale, from the University of Chicago, and colleagues point out in the Journal of Clinical Oncology.

The researchers assessed the emotional state of 67 men with a recurrence of prostate cancer indicated by a rising PSA level. A third of the men decided to start ADT quickly.

A high score on a scale measuring anxiety related to prostate cancer meant that a patient was 9 times more likely than someone with a lower score to choose early treatment.

The findings suggest that "the non-clinical factor of patient anxiety about cancer may be both important and overlooked in choosing when to initiate ADT," Dale and colleagues conclude.

It is important for patients and their doctors to discuss worries and anxieties about cancer, they add. "Doing so may help prevent unnecessary early initiation of a therapy with significant toxicities and questionable impact on life expectancy in otherwise asymptomatic older men."

SOURCE: Journal of Clinical Oncology, March 2, 2009.