title: The relationship between anxiety and time to treatment for patients with prostate cancer on surveillance.
abstract: OBJECTIVE
  Little is known about psychosocial factors affecting the decision to move from surveillance to active treatment in men with localized prostate cancer. We examined the impact of cancer anxiety on the decision to move from surveillance to treatment.
  
  
  METHODS
  We analyzed data from CaPSURE, a national observational prostate cancer registry. A total of 105 participants had localized disease, selected surveillance vs treatment and had at least 3 prostate specific antigen values available after baseline. Cancer anxiety was measured with a 3-item scale (alpha = 0.78). We calculated the rate of change in prostate specific antigen with time (prostate specific antigen velocity) and used the same formula to calculate the rate of change in cancer anxiety. We fit a Cox regression model to determine predictors of receiving treatment in the 3-year observation period, controlling for prostate specific antigen velocity, demographics and baseline clinical characteristics.
  
  
  RESULTS
  Prostate specific antigen velocity and the cancer anxiety change rate were significant independent predictors of treatment receipt (HR 1.02, 95% CI 1.004, 1.035, each p <0.01). Men with higher prostate specific antigen velocity (1.51 ng/ml per year or greater) were significantly more likely to receive treatment than men with lower prostate specific antigen velocity (HR 3.18, 95% CI 1.122, 9.016). The 2 velocity measures correlated only modestly (r = 0.29, p <0.001).
  
  
  CONCLUSIONS
  Rather than being based only on clinical presentation and disease progression, decisions about treatment receipt for some men are influenced by cancer related anxiety. Men should be provided with more psychosocial support to perhaps delay treatment and the ensuing decrements in health related quality of life.
authors.affiliation: Scott Department of Urology and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA. latini@bcm.tmc.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Latini
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Hart
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Knight
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.forename: Phillip L
authors.initials: PL
authors.lastname: Ross
authors.forename: Janeen
authors.initials: J
authors.lastname: Duchane
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications*; D003657:Decision Making; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D012959:Socioeconomic Factors
chemical_list: D017430:Prostate-Specific Antigen