Buffalo: The anxiety many men experience after being diagnosed with prostate cancer may lead them to choose potentially unnecessary treatment options, researchers from the University at Buffalo and Roswell Park Cancer Institute report in a new study. “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
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
“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
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
“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.