Emotional Distress from Prostate Cancer Diagnosis May Lead to Unnecessary Aggressive Treatment


Level of emotional distress after prostate cancer diagnosis increases likelihood of choosing surgery over active surveillance.

Receiving a cancer diagnosis can be emotionally taxing and put a patient in a state of anxiety. New research suggests the anxiety many men feel when diagnosed with prostate cancer can trigger the belief that a more aggressive approach is better, resulting in potentially unnecessary treatments.

The American Cancer Society estimates nearly 3 million prostate cancer survivors are alive today. Although this form of cancer is not a death sentence, the adverse effects caused by overtreatment are a concern.

In a study published in the Journal of Urology, investigators enrolled 1531 men with newly diagnosed, clinically localized prostate cancer.

The participants’ emotional distress was measured with the 11-point scale Distress Thermometer, ranging from 0 to 10, with 10 meaning extreme distress. Each patient was assessed after diagnosis, and again right after their treatment decision was made.

The majority of patients had either low- or intermediate-risk disease, and were more likely to have been treated with surgery, followed by radiation and active surveillance, according to the study.

The results of the study showed that the level of emotional distress shortly after diagnosis predicted a greater likelihood of choosing surgery over active surveillance. Importantly, these results were found to be true among men with low-risk disease “for whom active surveillance may be clinically viable option and side effects of surgery might be avoided,” the authors wrote.

Overtreatment is a concern in prostate cancer patients, and surgery and radiation therapy can come with adverse effects, such as erectile dysfunction and incontinence. These adverse effects can be avoided in a majority of men diagnosed with low-risk prostate cancer by choosing active surveillance first, and then 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,” said lead author Health Orom, PhD. “We don’t want men to make a decision that they’ll regret later on.”

The study results are noteworthy because it provides further knowledge on what drives men to choose certain treatments, and can help oncologists to better guide patients to the best treatment option.

“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 study co-author Willie Underwood III, MD, MS, MPH. “To do so, it is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotion distress to prevent men from receiving a treatment that they don’t need or will later regret.”

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