title: Mode of prostate cancer detection is associated with the psychological wellbeing of survivors: results from the PiCTure study.
abstract: OBJECTIVE
  Many men with prostate cancer are asymptomatic, diagnosed following prostate specific antigen (PSA) testing. We investigate whether mode of detection, i.e. 'PSA detected' or 'clinically detected', was associated with psychological wellbeing among prostate cancer survivors.
  
  
  METHODS
  A cross-sectional postal questionnaire was administered in 2012 to 6559 prostate cancer (ICD10 C61) survivors up to 18 years post-diagnosis, identified through population-based cancer registries in Ireland. Psychological wellbeing was assessed using the Depression Anxiety Stress Scale-21. Logistic regression was used to investigate associations between mode of detection and depression, anxiety and stress, adjusting for socio-demographic and clinical confounders.
  
  
  RESULTS
  The response rate was 54 % (3348/6262). Fifty-nine percent of survivors were diagnosed with asymptomatic PSA-tested disease. Prevalence of depression (13.8 vs 20.7 %; p < 0.001), anxiety (13.6 vs 20.9 %; p < 0.001) and stress (8.7 vs 13.8 %; p < 0.001) were significantly lower among survivors diagnosed with PSA-detected, than clinically detected disease. After adjusting for clinical and socio-demographic factors, survivors with clinically detected disease had significantly higher risk of depression (odds ratio (OR) = 1.46 95 % CI 1.18, 1.80; p = 0.001), anxiety (OR = 1.36 95 % CI 1.09, 1.68; p = 0.006) and stress (OR = 1.43 95 % CI 1.11, 1.85; p = 0.006) than survivors with PSA-detected disease.
  
  
  CONCLUSIONS
  These findings contribute to the ongoing debate on benefits and risks of PSA testing and may be considered by policy makers formulating population-based prostate cancer screening policies. The relatively high prevalence of negative psychological states among survivors means that a 'risk-adapted approach' should be implemented to screen survivors most at risk of psychological morbidity for psychological health, and mode of detection could be considered as a risk stratum.
authors.affiliation: National Cancer Registry Ireland, Building 6800, Airport Business Park, Kinsale Road, Cork, Ireland. francesjdrummond22@gmail.com.|School of Nursing and Midwifery, University College Cork, Cork, Ireland. francesjdrummond22@gmail.com.
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Drummond
authors.affiliation: National Cancer Registry Ireland, Building 6800, Airport Business Park, Kinsale Road, Cork, Ireland.
authors.forename: Eamonn
authors.initials: E
authors.lastname: O'Leary
authors.affiliation: Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6BJ, Ireland.
authors.forename: Anna
authors.initials: A
authors.lastname: Gavin
authors.affiliation: Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6BJ, Ireland.
authors.forename: Heather
authors.initials: H
authors.lastname: Kinnear
authors.affiliation: National Cancer Registry Ireland, Building 6800, Airport Business Park, Kinsale Road, Cork, Ireland.|University of Newcastle, Tyne and Wear, Newcastle upon Tyne, NE1 7RU, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology
keywords: Anxiety; Depression; PSA; Prostate cancer; Prostate specific antigen; Screening; Stress