Patient Distress in Prostate Cancer Could Lead to Overtreatment

Heather Orom, PhD

Heather Orom, PhD

Patients diagnosed with prostate cancer sometimes allow their feelings of distress and anxiety to influence their treatment choices, which can potentially lead to unnecessary procedures, according to researchers at the University of Buffalo.

For men with low-risk prostate cancer, active surveillance may be considered the best treatment option in their situation. However, many in this population choose to undergo surgery or radiation, largely due to the anxiety they feel.

Published in the Journal of Urology, the study followed 1531 patients with localized prostate cancer (36% low-risk, 49% intermediate-risk, and 15% high-risk). Researchers evaluated the emotional distress of the patients soon after diagnosis and after a treatment decision. This evaluation was done using the Distress Thermometer, an 11-point scale that ranges from 0 (no distress) to 10 (extreme distress). The aim was to discover if a man’s level of distress could predict his treatment choices.

Among all participants, men who felt more anxiety at diagnosis were more likely to choose surgery over active surveillance. Similarly, men who were more distressed around the time they made the treatment decision were likely to choose surgery over active surveillance, as well as surgery over radiation.

The researchers said of this pattern, “Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided.”

According to the American Cancer Society, prostate cancer is a major disease in the United States, but its diagnosis is not synonymous with death. The organization says there are nearly 3 million prostate cancer survivors alive today.

Despite these facts, many patients feel distress strong enough to influence decisions that could lead to overtreatment. Surgery and radiation have side effects such as erectile dysfunction and incontinence, which can affect patient quality of life. These side effects can be safely avoided for men with low-risk cancer by choosing active surveillance, which is used to closely follow the potential progression of cancer. Treatment can still be considered later if the cancer becomes more concerning.

To help men make treatment decisions that are more preference and value driven, it is important they receive all information pertinent to their situation, including the side effects of all treatments.

Lead author on the study, Heather Orom, PhD, said, “If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety.”

Additionally, physicians should take time to understand the reasoning behind their treatment decision and address any negative motivators, such as anxiety, to make sure patients do not receive treatment they don’t need and might potentially regret.

Orom H, Underwood W, Biddle C. Emotional distress increases the likelihood of undergoing surgery among men with localized prostate cancer. J Urol. 2017;197(2):350-355.