The role of anxiety in prostate carcinoma: a structured review of the literature

Abstract

Although the impact of anxiety on patients with some types of cancer is well recognized, to the authors knowledge its impact on patients with prostate carcinoma has not been studied as thoroughly. The authors conducted a systematic review of the medical literature for high-quality articles that quantified anxiety levels in men with prostate carcinoma and identified 29 articles. Using the clinical timeline of prostate carcinoma to organize the articles, cross-sectional studies that reflected anxiety prevalence in populations and longitudinal studies that reflected changes in anxiety over time were identified. Anxiety appeared to fluctuate over the clinical timeline in response to stressors and uncertainty (such as at the time of screening and/or biopsy), rising before these times and falling afterward. Although anxiety levels in men age > 55 years who were at risk for prostate carcinoma were modest (10-15%), multiple studies found that these levels were substantially higher in men who presented for screening (> 50%), and "seeking peace of mind" was the motivation cited most frequently for pursuing screening. Most studies demonstrated a significant decrease in anxiety levels after a normal screening or biopsy result, although the proportion of men who remained anxious afterward did not fall to baseline levels (20-36%). Men who presented for prostate-specific antigen monitoring after treatment had elevated anxiety levels at the time of testing (23-33%). Many years after therapy for localized disease, anxiety levels were lower after prostatectomy (23%) compared with the levels after watchful waiting (31%).

(c) 2005 American Cancer Society.

Figures

FIGURE 1

This chart illustrates the timeline of anxiety in prostate carcinoma and summarizes findings from the literature using standardized anxiety measures. Text boxes represent relevant patient populations at selected times in the potential course of screening, diagnosis, treatment, and follow-up. Cross-sectional studies of population anxiety levels are reported in these boxes. Lines connecting boxes represent transition points between populations when anxiety levels may change, and longitudinal studies that assessed changes in a population over time provided evidence for these relations. Finally, italicized text represents important decision-making points, such as screening tests, biopsy results, and treatment choices. Except for “Baseline,” details for the reported percentages are included in Table 3, including the anxiety measurement scales used and the definitions of cut-off values for determining a “case” of anxiety. For details on longitudinal changes in anxiety levels across populations, see Table 4 for studies and measurement instruments. Superscript numerals indicate references. PSA: prostate-specific antigen.