Emotionally Distressed Prostate Cancer Patients May Ask for Overly Aggressive Therapy

by Daniela Semedo 

Men with low-risk prostate cancer who are not emotionally well may ask doctors for a more aggressive treatment regimen when it may not be necessary, a study suggests.

The research, “
Emotional Distress Increases the Likelihood of Undergoing Surgery among Men with Localized Prostate Cancer,” was published in the Journal of Urology.

Prostate cancer is the most common malignancy among elderly men and the second leading malignancy in the Western world. Among men with localized prostate cancer, those with a low-risk disease have extremely low rates of cancer-specific mortality within 10 years of 

In these cases, many doctors prefer to offer patients 
watchful waiting or active surveillance of their disease. Despite this, prostate cancer over-treatment can occur among men with low-risk disease — at the men’s behest.

Heather Orom, PhD, assistant dean for equity, diversity and inclusion at the School of Public Health and Health Professions of University at Buffalo and her colleagues

University of Buffalo researchers sought to determine if emotional distress could increase the likelihood of a patient having to undergo surgery — versus radiation or active surveillance — in men with localized prostate cancer, particularly those with low-risk disease.

Heather Orom, PhD, and her colleagues measured emotional distress in 1,531 men recruited from two academic and three community facilities. Orom is assistant dean for equity, diversity and inclusion at the University of Buffalo’s School of Public Health and Health Professions.

Eight-three percent of the men the researchers studied were non-Hispanic whites. Eleven percent were non-Hispanic blacks and 6 percent were Hispanics.

Thirty-six percent of the patients had low-risk disease, 49 percent intermediate-risk prostate cancer, and 15 percent high-risk disease. Twenty-four percent chose active surveillance, 27 percent opted for radiation, and 48 percent decided to have surgery.

Emotional distress was assessed shortly after diagnosis and shortly after a treatment decision. Researchers measured distress with a Distress Thermometer, a self-report using a 0-10 scale, in which 0 meant “No distress” and 10 meant “Extreme distress.”

The mean emotional distress level was 4.37 after diagnosis, and 4.1 after a patient made a treatment decision.

Overall, men who were emotionally distressed at diagnosis were more likely to choose surgery over active surveillance, the researchers said. Similarly, men with higher emotional distress close to the time they made a treatment choice were 16 percent more likely to choose surgery over active surveillance and 12 percent more likely to choose surgery over radiation.

In men with low-risk disease, emotional distress shortly after diagnosis was also found to be associated with choosing surgery over active surveillance. Similarly, distress around the time of a treatment decision increased the likelihood of the men choosing surgery over active surveillance and 
radiation therapy.

Among those with intermediate-risk disease, emotional distress at decision-making was associated with a greater likelihood of choosing surgery over active surveillance and radiation therapy. However, for these men, emotional distress shortly after diagnosis was not associated with treatment choice.

Researchers found no link between emotional distress and treatment choice among men with high-risk disease.

The research team concluded that addressing emotional distress before and while a man is making a treatment decision may lead to more active-surveillance choices.

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