“Emotional distress may motivate men with low-risk prostate
cancer to choose more aggressive treatment, such as choosing surgery over
active surveillance,” said UB’s Heather Orom, the lead author on the study,
published in the February issue of the Journal of Urology.
“It underscores what we have been pushing a long time for,
which is, ‘Let’s make this decision as informed and supported as possible.’ 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. We hope this will help improve the treatment decision making process
and ultimately, the patient’s quality of life,” added Orom, PhD, associate
professor of community health and health behavior in UB’s School of Public
Health and Health Professions.
The study involved 1,531 men with newly diagnosed, clinically
localized prostate cancer, meaning the disease hadn’t spread to other parts of
the body.
Researchers measured participants’ emotional distress with the
Distress Thermometer, an 11-point scale ranging from 0 (no distress) to 10
(extreme distress). The men were assessed after diagnosis and again as soon as
they had made their treatment decision.
The majority of study participants had either low- or
intermediate-risk disease, and were more likely to have been treated with
surgery, followed by radiation and active surveillance.
“Men’s level of emotional distress shortly after diagnosis
predicted greater likelihood of choosing surgery over active surveillance,” the
researchers report.
“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.”
While prostate cancer is a major disease in the U.S., it is
not a death sentence, according to the American Cancer Society, which estimates
there are nearly 3 million prostate cancer survivors alive today.
However, overtreatment is a concern, and surgery and radiation
therapy have side effects that include erectile dysfunction and incontinence,
which, for the majority of men diagnosed with low-risk prostate cancer, can be
avoided by instead choosing active surveillance to monitor the cancer and
considering treatment if the disease progresses.
“There’s an interest in driving the decision-making experience
to prevent overtreatment and ensure that men have full information about all
the side effects so they can make a choice that’s preference and value driven,”
Orom said. “We don’t want men to make a decision that they’ll regret later on.”
“The goal of most physicians treating men with prostate cancer
is to help their patients and family members through a difficult process and
help their patients receive appropriate treatment,” said Willie
Underwood III, MD, MS, MPH, an associate professor in Roswell Park’s
Department of Urology, and a paper co-author.
“To do so, it is helpful for physicians to better understand
what is motivating men’s decisions and to address negative motivators such as
emotional distress to prevent men from receiving a treatment that they don’t
need or will later regret,” Underwood added.
Caitlin Biddle, a PhD candidate in community health and health
behavior at UB, is also a co-author on the paper.
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