title: Wellbeing during Active Surveillance for localised prostate cancer: a systematic review of psychological morbidity and quality of life.
abstract: BACKGROUND
  Active Surveillance (AS) is recommended for the treatment of localised prostate cancer; however this option may be under-used, at least in part because of expectations of psychological adverse events in those offered or accepting AS.
  
  
  OBJECTIVE
  (1) Determine the impact on psychological wellbeing when treated with AS (non-comparative studies). (2) Compare AS with active treatments for the impact on psychological wellbeing (comparative studies).
  
  
  METHODS
  We used the PRISMA guidelines and searched Medline, PsychInfo, EMBASE, CINHAL, Web of Science, Cochrane Library and Scopus for articles published January 2000-2014. Eligible studies reported original quantitative data on any measures of psychological wellbeing.
  
  
  RESULTS
  We identified 34 eligible articles (n=12,497 individuals); 24 observational, eight RCTs, and two other interventional studies. Studies came from North America (16), Europe (14) Australia (3) and North America/Europe (1). A minority (5/34) were rated as high quality. Most (26/34) used validated instruments, whilst a substantial minority (14/34) used watchful waiting or no active treatment rather than Active Surveillance. There was modest evidence of no adverse impact on psychological wellbeing associated with Active Surveillance; and no differences in psychological wellbeing compared to active treatments.
  
  
  CONCLUSIONS
  Patients can be informed that Active Surveillance involves no greater threat to their psychological wellbeing as part of the informed consent process, and clinicians need not limit access to Active Surveillance based on an expectation of adverse impacts on psychological wellbeing.
authors.affiliation: Centre for Translational Neuroscience and Mental Health, School of Medical Practice and Population Health, Faculty of Health, University of Newcastle, NSW, Australia. Electronic address: gregory.carter@newcastle.edu.au.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
authors.affiliation: Psycho-Oncology Service, Calvary Mater Newcastle, School of Psychology, Faculty of Science and Information Technology, Centre for Translational Neuroscience & Mental Health Research, University of Newcastle, Australia.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Clover
authors.affiliation: Psycho-Oncology Service, Calvary Mater Newcastle, School of Psychology, Faculty of Science and Information Technology, Centre for Translational Neuroscience & Mental Health Research, University of Newcastle, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Britton
authors.affiliation: Depart of Cancer & Molecular Medicine, Leicester Royal Infirmary & University of Leicester, Leicester LE5 1WW, United Kingdom.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Consultant Urologist, New Lambton, Newcastle, NSW, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: White
authors.affiliation: John Hunter Hospital, New Lambton, Newcastle, NSW, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: McLeod
authors.affiliation: Faculty of Health and Medicine, Prostate Cancer Trials Group, School of Medicine and Public Health, University of Newcastle, NSW, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Denham
authors.affiliation: Ingram School of Nursing, McGill University, Canada.
authors.forename: Sylvie D
authors.initials: SD
authors.lastname: Lambert
mesh_terms: D062665:Epidemiological Monitoring; D006801:Humans; D008297:Male; D009017:Morbidity; D011471:Prostatic Neoplasms / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*
keywords: Active Surveillance; Anxiety; Depression; Distress; Prostate cancer; Quality of life; Stress; Wellbeing