Active Surveillance, Depression and Anxiety

There’s been a noticeable uptick in urologists recommending active surveillance (AS) for patients diagnosed with early stage, low risk prostate cancer (PCa). NOTE: For purposes of this blog entry, I’m assuming the diagnosis was accurate and did not miss any biomarkers for hidden aggressive cell lines.

Indeed, recent studies have shown that more men are, in fact, choosing to go on AS as a way to delay treatment and its accompanying risks of urinary and sexual harm. For the majority of men on AS, they are comfortable with the tradeoff of taking on some worry in exchange for avoiding treatment for the time being. However, according to a new British study, nearly a quarter of men on AS will become depressed and anxious.[i] It’s an interesting study because it took into account not just how many men had some degree of emotional turmoil, but also the demographics of the population being studied.

The cohort was comprised of 313 men on AS. They ranged in age from 51-86 years (mean age 70). Three-fourths (76%) were married or in civil partnerships, and the majority (94%) were Caucasian. In addition, their employment and educational background were recorded. All of them were given a questionnaire called the Hospital Anxiety and Depression Scale (HADS). Their demographic data was correlated with their HADS score to take into account other variables besides prostate cancer and AS that might account for depression and anxiety. Finally, their scores were compared with available data on comparable non-PCa patients in the general population.

The authors found that the AS patients were twice as likely to be depressed as non-PCa patients, and three times as likely to experience anxiety. (The only general demographic predictor for anxiety or depression was being divorced.) Of special note is the tendency of AS patients toward “substantially greater levels of anxiety than patients with PCa treated radically.” The authors found that their results were consistent with smaller published studies on the same topic. They report some evidence that self-care tools such as information available on the internet may help reduce the inner toll of those affected by negative emotions while on AS, but more research is needed on ways to meet their needs.

Other studies have repeatedly shown that when worry becomes too great, men on AS opt for treatment. This is one area where focal therapy such as Focal Laser Ablation (FLA) offers an advantage over AS. Although long-term success data for FLA has not yet been established, the majority of our own patients including some who are more than five years out from treatment have experienced durable results. They are able to have normal lives, monitor success by imaging and complex PSA blood tests, and be liberated from fear and depression. They know that if necessary, FLA can be repeated—or they can choose any other treatment if cancer comes back.

At the Sperling Prostate Center, we feel rewarded knowing that our treatment alleviates the worry and depression that can erode the peace of mind of many AS patients. If you are on AS and are not entirely comfortable with it, give us a call to find out if you are a candidate for FLA.

[i] Watts S, Leydon G, Eyles C et al. A quantitative analysis of the prevalence of clinical depression and anxiety in patients with prostate cancer undergoing active surveillance. BMJ Open. 2015 May 22;5(5):e006674. doi: 10.1136/bmjopen-2014-006674.