title: Does active surveillance for men with localized prostate cancer carry psychological morbidity?
abstract: OBJECTIVE
  To investigate, in a cross-sectional study, the prevalence of anxiety and depression in patients with localised prostate cancer managed by active surveillance, compared with those receiving immediate treatment, as active surveillance is a relatively new approach to managing this disease, designed to avoid 'unnecessary' treatment, but it is unclear whether the approach contributes to psychological distress, given that men are living with untreated cancer.
  
  
  METHODS
  A consecutive series of 764 patients with prostate cancer were approached in outpatient clinics. Of these, 329 men with localized disease (cT1/2, N0/NX, M0/MX) meeting the study entry criteria, completed the Hospital Anxiety and Depression Scale (HADS); 100 were on active surveillance, 81 were currently receiving radical treatment (radiotherapy + neoadjuvant hormone therapy) and 148 had previously received radical radiotherapy.
  
  
  RESULTS
  Overall, 16% (51/329) of patients met the HADS criteria for anxiety and 6% (20/329) for depression. Analyses indicated that higher anxiety scores were significantly associated with younger age (P < 0.01) and a longer interval since diagnosis (P < 0.01), but not with management by active surveillance (P = 0.38). Higher depression scores were significantly associated with a longer interval since diagnosis (P < 0.05), but not with management by active surveillance (P = 0.83).
  
  
  CONCLUSIONS
  Active surveillance for managing localized prostate cancer was not associated with greater psychological distress than more immediate treatment for prostate cancer.
authors.affiliation: Psychological Medicine, Royal Marsden NHS Foundation Trust, London, UK. katriina.burnet@rmh.nhs.uk
authors.forename: Katriina L
authors.initials: KL
authors.lastname: Burnet
authors.forename: Chris
authors.initials: C
authors.lastname: Parker
authors.forename: David
authors.initials: D
authors.lastname: Dearnaley
authors.forename: Chris R
authors.initials: CR
authors.lastname: Brewin
authors.forename: Maggie
authors.initials: M
authors.lastname: Watson
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001008:Anxiety Disorders / Q000209:etiology*; D001294:Attitude to Health; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life