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Rönningås U, Holm M, Fransson P, Beckman L, Wennman-Larsen A. Symptoms and quality of life among men starting treatment for metastatic castration-resistant prostate cancer - a prospective multicenter study. BMC Palliat Care 2024; 23:80. [PMID: 38532425 DOI: 10.1186/s12904-024-01410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Men with metastatic castration-resistant prostate cancer (mCRPC) have an incurable disease. Along with prolonging life, symptom management is one of the main goals with treatment. This is also important from a palliative care perspective where the life prolonging outcomes should be balanced with quality of life (QoL) in this late phase. It is also essential in symptom management to view different dimensions of symptoms, for example how severe or distressing symptoms are, to support best QoL. Therefore, more knowledge is needed about the symptom experience when these treatments are initiated and thus the aim of this study was to describe different dimensions of symptoms in men with mCRPC starting their first-line of life-prolonging treatment, and to describe the association between symptom burden and QoL. METHODS Baseline data from a prospective longitudinal study of 143 men with mCRPC starting their first-line life-prolonging treatment were used. Symptoms were measured using the Memorial Symptom Assessment Scale (MSAS) and global QoL was measured by the EORTC QLQ C-30. Data was analyzed using descriptive- and multivariable linear regression analyses. RESULTS On average, the men had more than 10 symptoms (range 0-31 of 33). 50% or more reported sweats, lack of energy, pain, problems with sexual activity and sexual desire. The symptoms they reported as most severe, or most distressing were not always the ones that were reported as most frequent. There was an association between QoL and physical symptoms, and also between QoL, and analgesic use and prostate-specific antigen (PSA) values. CONCLUSION Even if some men with mCRPC report many symptoms, the dimensions of severity and distress levels vary, and the most frequent symptoms was not always the most burdensome or distressing. There was an association between high physical symptom burden and QoL, suggesting that it is not the number of symptoms that affects QoL but rather the subjective perceived impact of the physical symptoms experienced. The knowledge of how men with mCRPC experience and perceive their symptoms may help health care professionals in symptom management aiming to improve QoL, which is a cornerstone in integrating early palliative care.
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Affiliation(s)
- Ulrika Rönningås
- Department of Nursing, Umeå University, Umeå, 901 87, Sweden.
- Department of Oncology, Sundsvall County Hospital, Sundsvall, Sweden.
| | - Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University College, Stockholm, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, 901 87, Sweden
| | - Lars Beckman
- Department of Oncology, Sundsvall County Hospital, Sundsvall, Sweden
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Agneta Wennman-Larsen
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Kim DY, Ryu JH, Yoo TK, Kim YB, Jung TY, Ko WJ, Yang EK. Analysis of distress in patients undergoing radical prostatectomy: A multicenter prospective study. Investig Clin Urol 2024; 65:40-52. [PMID: 38197750 PMCID: PMC10789535 DOI: 10.4111/icu.20230286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE To analyze the degree of psychological distress experienced pre- and postoperatively in patients who underwent radical prostatectomy after being diagnosed with prostate cancer. MATERIALS AND METHODS Patients diagnosed with prostate cancer who underwent radical prostatectomy without history of psychiatric disorders were included in this study. The degree of psychological distress was evaluated using hospital anxiety and depression scale (HADS) and distress thermometer (DT) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS Distress was high preoperatively and decreased over the entire period. In addition, HADS-anxiety and HADS-depression scores showed an improved severity, shifting from an abnormal state to a borderline state in some patients. However, the DT score, including emotional problems, spiritual concerns, physical problems, family problems, and practical problems, was slightly higher at 1 month postoperatively compared to preoperatively. Furthermore, even at 12 months postoperatively, about one fifth of patients surveyed had a DT score of 4 or higher, requiring psychiatric intervention. CONCLUSIONS Before and after radical prostatectomy, a significant number of patients complained of distress such as anxiety, depression, and insomnia, and they needed help from a specialist because of psychological distress even 12 months postoperatively. Therefore, a close evaluation of the patient's psychological distress and supportive treatment are needed during the entire pre- and postoperative period.
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Affiliation(s)
- Duk Yoon Kim
- Department of Urology, School of Medicine, Daegu Catholic University, Daegu, Korea.
| | - Jae Hyun Ryu
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Yun Beom Kim
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | - Woo Jin Ko
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eun Kyoung Yang
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu, Korea
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Sievert KD, Hansen T, Titze B, Schulz B, Omran A, Brockkötter L, Gunnemann A, Titze U. Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics. Diagnostics (Basel) 2022; 12:diagnostics12051146. [PMID: 35626301 PMCID: PMC9140526 DOI: 10.3390/diagnostics12051146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.
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Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Torsten Hansen
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Barbara Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Birte Schulz
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
| | - Ahmad Omran
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Lukas Brockkötter
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Alfons Gunnemann
- Department of Urology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (K.-D.S.); (A.O.); (L.B.); (A.G.)
| | - Ulf Titze
- Institute of Pathology, University Hospital OWL of the University of Bielefeld, Campus Lippe, 32756 Detmold, Germany; (T.H.); (B.T.); (B.S.)
- Correspondence: ; Tel.: +49-05231-72-3451
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Rönningås U, Holm M, Doveson S, Fransson P, Beckman L, Wennman-Larsen A. Signs and symptoms in relation to progression, experiences of an uncertain illness situation in men with metastatic castration-resistant prostate cancer-A qualitative study. Eur J Cancer Care (Engl) 2022; 31:e13592. [PMID: 35411645 PMCID: PMC9540658 DOI: 10.1111/ecc.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
Objective Signs and symptoms are important in monitoring prostate cancer, but there is a lack of understanding about the men's interpretation of signs and symptoms in relation to disease progression in advanced phases of the disease. The aim was to illuminate the experience of signs and symptoms in relation to disease progression in men with metastatic castration‐resistant prostate cancer (mCRPC). Method Thirty longitudinal interviews were conducted with 11 men undergoing life‐prolonging treatment for mCRPC. Conventional content analysis was used. Results The results illuminate an uncertainty that the men experience when interpreting signs and symptoms. The overarching theme was The experience of an uncertain illness situation within the framework of progression, with four subthemes: Symptoms triggering thoughts about disease progression; Making sense of signs, also in the absence of symptoms; Making sense of symptoms during treatment; Progression triggering thoughts about the remainder of life. Conclusion In the uncertain illness situation, the men strive to make sense of signs and symptoms based on previous experiences and in relation to disease progression. Understanding the men's perspectives on signs and symptoms in this late phase may help health care professionals communicate about disease progression considering the balance between treatment outcome and quality of life.
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Affiliation(s)
- Ulrika Rönningås
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Sundsvall County Hospital, Sundsvall, Sweden.,Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
| | - Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden.,Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University College, Stockholm, Sweden
| | - Sandra Doveson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden.,Cancercentrum, Norrlands University Hospital, Umeå, Sweden
| | - Lars Beckman
- Department of Oncology, Sundsvall County Hospital, Sundsvall, Sweden
| | - Agneta Wennman-Larsen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
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James C, Brunckhorst O, Eymech O, Stewart R, Dasgupta P, Ahmed K. Fear of cancer recurrence and PSA anxiety in patients with prostate cancer: a systematic review. Support Care Cancer 2022; 30:5577-5589. [PMID: 35106656 PMCID: PMC9135793 DOI: 10.1007/s00520-022-06876-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/27/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The impact of prostate cancer on the mental wellbeing of patients is increasingly being appreciated. Two important aspects of this include fear of cancer recurrence (FCR) and prostate-specific antigen (PSA) anxiety. However, their prevalence, severity and associating factors remain poorly understood. Therefore, this review aims to evaluate the current evidence for the prevalence, severity and associating features of PSA anxiety and FCR. METHODS A systematic search of MEDLINE, EMBASE and PsycINFO databases was conducted by two independent reviewers. Observational studies measuring FCR and PSA anxiety in prostate cancer using validated measures were included. Outcome measures were prevalence of significant levels, mean scores and significant correlations of FCR and PSA anxiety scores with patient, disease, treatment or other mental health and quality of life outcomes. RESULTS One thousand one hundred forty-eight individual records underwent screening with 32 studies included. Median prevalence of significant FCR and PSA anxiety was 16% and 22% respectively across all studies. Longitudinal studies demonstrated severity of both symptoms peaks at diagnosis, with little variability, even several years following this. Evaluating associating factors revealed younger age, generalised quality of life and mental health symptoms to be important factors for both outcomes. Few studies evaluated associations and differences between other patient, disease and treatment characteristics. CONCLUSION FCR and PSA anxiety are prominent symptoms for prostate cancer patients and importantly when present, are associated with poorer quality of life and mental health symptoms. Screening for these constructs and referral to appropriate services should form part of routine follow-up care.
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Affiliation(s)
- Callum James
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.
| | - Omar Eymech
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Robert Stewart
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Department of Urology, King's College Hospital, London, UK
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Gedye C, Navani V. Find the path of least resistance: Adaptive therapy to delay treatment failure and improve outcomes. Biochim Biophys Acta Rev Cancer 2022; 1877:188681. [PMID: 35051527 DOI: 10.1016/j.bbcan.2022.188681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
Cytotoxic chemotherapy and targeted therapies help people with advanced cancers, but for most, treatment fails. Cancer heterogeneity is one cause of treatment failure, but also suggests an opportunity to improve outcomes; reconceptualising cancer therapy as an ecological problem offers the strategy of adaptive therapy. If an agent is active against a patient's cancer, instead of traditional continuous dosing at the maximum tolerated dose until treatment failure, the patient and their oncologist may instead choose to pause treatment as soon as the cancer responds. When tumour burden increases, the cancer is rechallenged with the same agent in hope of delivering another response, ideally before symptoms occur or quality-of-life is impacted. These 'loops' of 'pause/restart' allows an active treatment to be used strategically, to delay the development of evolutionary selection within the cancer, delaying the onset of treatment resistance, controlling the cancer for longer. Modelling predicts patients can navigate several 'loops', potentially increasing the utility of an active treatment by multiples, and early trials suggest at least doubling of progression-free survival. In this narrative review we confront how cancer heterogeneity limits treatment effectiveness, re-examine cancer as an ecological problem, review the data supporting adaptive therapy and outline the challenges and opportunities faced in clinical practice to implement this evolutionary concept. In an era where multiple novel active anti-neoplastic agents are being used with ancient inflexibile maximum tolerated dose for maximum duration approaches, adaptive dosing offers a personalised, n = 1 approach to cancer therapy selection.
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Affiliation(s)
- Craig Gedye
- Calvary Mater Newcastle, Waratah 2298, NSW, Australia; Clinical Trial Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; School of Medicine and Public Health University of Newcastle, NSW, Australia.
| | - Vishal Navani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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Post-prostatectomy adjuvant androgen deprivation therapy- Current opinions and practices of Canadian urologists. Urol Oncol 2021; 40:57.e9-57.e14. [PMID: 34303596 DOI: 10.1016/j.urolonc.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the proven benefit of adjuvant androgen deprivation therapy (ADT) for patients receiving primary radiation, there are few studies evaluating adjuvant ADT after prostatectomy. In the absence of evidence, opinions and practice patterns vary. We surveyed Canadian prostate cancer surgeons about their use of adjuvant ADT and their opinions on the design of a potential adjuvant ADT trial. METHODS An electronic survey was devised and distributed using a modified Dillman approach. The survey was sent to 38 Canadian urologists that perform radical prostatectomy and representing all 17 major academic institutions in Canada and all 10 Canadian provinces. Reminders were sent three and four weeks following the original request. In addition to demographic information, we asked surgeons about their current use of postoperative adjuvant ADT and their opinion about the need for a clinical trial. To inform trial design, we asked respondents their opinions about which patients should be eligible, what duration of ADT was most appropriate, and which outcomes are clinically meaningful. The survey was sent in February 2020 and all responses were received by March 2020. RESULTS All 38 (100%) invited urologists completed the survey. Only 3 (7%) respondents currently offer postoperative adjuvant ADT as an option for patients without metastases. 35 (92%) urologists believed that a trial is needed before short-term adjuvant treatment should be offered to prevent recurrence. 15 (45%) urologists believed an adjuvant ADT trial was most appropriate for patients with an estimated PSA recurrence risk of >25% and 16 (42%) believed a recurrence risk of >50% was most appropriate. 25 (66%) respondents believed 12-month was the optimal duration of treatment with adjuvant ADT for a randomized trial. 37 (97%) respondents felt that prolonging the time to PSA recurrence and/or pelvic radiation was a clinically important outcome. The majority (20; 53%) of respondents would recommend 12 months of adjuvant ADT in their practice if a randomized trial showed a 50% relative risk reduction in PSA recurrence at 5-year postoperative. CONCLUSION The vast majority of Canadian prostate cancer surgeons do not offer adjuvant ADT following prostatectomy in patients without metastases. Based on the results from this survey, a randomized trial was considered warranted and feasible, and would influence patient care.
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Zhu J, Chen R, Davidsson S, Carlsson J, Messing-Eriksson A, Fridfeldt J, Andrén O, Andersson SO, Valdimarsdóttir U, Fang F, Fall K. Psychological and physiological impacts of a fast-track diagnostic workup for men with suspected prostate cancer: Preliminary report from a randomized clinical trial. Cancer Commun (Lond) 2020; 40:239-242. [PMID: 32255568 PMCID: PMC7238668 DOI: 10.1002/cac2.12021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/03/2020] [Accepted: 03/11/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jianwei Zhu
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, 610000, P. R. China
| | - Ruoqing Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 171 77, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, 701 85, Sweden
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, 701 85, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, 701 85, Sweden
| | - Anna Messing-Eriksson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, 701 85, Sweden
| | - Jonna Fridfeldt
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, 701 85, Sweden
| | - Ove Andrén
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, 701 85, Sweden
| | - Sven-Olof Andersson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, 701 85, Sweden
| | - Unnur Valdimarsdóttir
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, 610000, P. R. China.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 171 77, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, SA
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, 701 85, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, 171 77, Sweden
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Phase 2 trial of monoamine oxidase inhibitor phenelzine in biochemical recurrent prostate cancer. Prostate Cancer Prostatic Dis 2020; 24:61-68. [PMID: 32123315 PMCID: PMC7483294 DOI: 10.1038/s41391-020-0211-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 11/17/2022]
Abstract
Purpose: Monoamine oxidase A (MAOA) influences prostate cancer growth and metastasis in pre-clinical models. We examined effects of phenelzine (a monoamine oxidase inhibitor) in patients with biochemical recurrent castrate-sensitive prostate cancer. Materials and methods: An open-label single arm clinical trial enrolled subjects with biochemical recurrent prostate cancer defined by: PSA ≥ 0.4 ng/ml (post-prostatectomy) or PSA ≥ 2 ng/ml above nadir (post-radiation therapy); no evidence of metastasis on imaging; and normal androgen levels. Subjects received phenelzine 30 mg orally twice daily. Mood symptoms were assessed with the hospital anxiety depression score (HADS) questionnaire. The primary endpoint was the proportion of patients who achieved a PSA decline of ≥50% from baseline. Results: Characteristics of the 20 eligible patients enrolled included: mean ± SD age 66.9± 4.8 years and PSA 4.7± 5.8 ng/dl. Maximal PSA declines ≥ 30% and ≥ 50% were observed in 25% (n=5/20) and 10% (n=2/20) of subjects, respectively. At 12 weeks, 17 subjects remained on treatment with PSA declines ≥ 30% and ≥ 50% of 24% (n=4/17) and 6% (n=1/17), respectively. Common toxicities observed included dizziness (grade 1 = 45%, grade 2= 35%), hypertension (grade ≥ 2 =30%), and edema (grade 1=25%, grade 2=10%). There was 1 episode of grade 4 hypertension (cycle 4) and 2 episodes of grade 3 syncope (cycle 12 and cycle 14) requiring treatment discontinuation. HADS questionnaires demonstrated a significant decrease in anxiety with no change in depressive symptoms on treatment. Conclusions: Phenelzine demonstrated efficacy in patients with biochemical recurrent castrate sensitive prostate cancer. Most treatment related toxicities were mild, but rare significant and reversible cardiovascular toxicities were observed. Therapies directed at MAOA may represent a new avenue for treatment in patients with recurrent prostate cancer. Trial registration: ClinicalTrials.gov Identifier: ClinicalTrial: NCT02217709
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Rönningås U, Fransson P, Holm M, Wennman-Larsen A. Prostate-specific antigen (PSA) and distress: - a cross-sectional nationwide survey in men with prostate cancer in Sweden. BMC Urol 2019; 19:66. [PMID: 31299962 PMCID: PMC6626380 DOI: 10.1186/s12894-019-0493-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/02/2019] [Indexed: 02/01/2023] Open
Abstract
Background The prostate-specific antigen (PSA) -value is often used during the prostate cancer trajectory as a marker of progression or response to treatment. Concerns about PSA-values are often expressed by patients in clinical situations. Today there is a lack of larger studies that have investigated the association between PSA-value and distress. The aim was to investigate the association between PSA-values and distress adjusted for sociodemographic factors, hormonal therapy and quality of life (QoL), among men with prostate cancer. Methods In this cross-sectional survey of 3165 men with prostate cancer, members of the Swedish Prostate Cancer Federation, answered questions about sociodemographic factors, PSA, distress, QoL and treatments. Descriptive statistics, and bivariate and multivariable analyses were performed. The result was presented based on four PSA-value groups: 0–19, 20–99, 100–999, and ≥ 1000 ng/ml. Results Of the men, 53% experienced distress. An association between distress and PSA-values was found where higher PSA-values were associated with higher OR:s for experiencing distress in the different PSA-groups: 0–19 ng/ml (ref 1), 20–99 ng/ml (OR 1.25, 95% CI 1.01–1.55), 100–999 ng/ml (OR 1.47, 95% CI 1.12–1.94), ≥1000 ng/ml (OR 1.77, 95% CI 1.11–2.85). These associations were adjusted for sociodemographic factors and hormonal therapy. In the multivariable analyses, beside PSA-values, higher levels of distress were associated with being without partner or hormonal therapy. When adding QoL in the multivariable analysis, the association between PSA and distress did not remain significant. Conclusion These results indicate that the PSA-values are associated with distress, especially for those with higher values. However, to be able to support these men, continued research is needed to gain more knowledge about the mechanisms behind the association between emotional distress and PSA-values.
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Affiliation(s)
- Ulrika Rönningås
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Oncology, Sundsvall County Hospital, 851 86, Sundsvall, Sweden. .,Department of Nursing Science, Sophiahemmet University, 114 86, Stockholm, Sweden.
| | - Per Fransson
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden.,Cancercentrum, Norrlands University Hospital, 901 85, Umeå, Sweden
| | - Maja Holm
- Department of Nursing Science, Sophiahemmet University, 114 86, Stockholm, Sweden
| | - Agneta Wennman-Larsen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Nursing Science, Sophiahemmet University, 114 86, Stockholm, Sweden
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11
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Bail JR, Traeger L, Pirl WF, Bakitas MA. Psychological Symptoms in Advanced Cancer. Semin Oncol Nurs 2018; 34:241-251. [DOI: 10.1016/j.soncn.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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12
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Evans JD, Jethwa KR, Ost P, Williams S, Kwon ED, Lowe VJ, Davis BJ. Prostate cancer–specific PET radiotracers: A review on the clinical utility in recurrent disease. Pract Radiat Oncol 2018; 8:28-39. [DOI: 10.1016/j.prro.2017.07.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 01/08/2023]
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13
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Patients' perceptions and attitudes on recurrent prostate cancer and hormone therapy: Qualitative comparison between decision-aid and control groups. J Geriatr Oncol 2017; 8:368-373. [DOI: 10.1016/j.jgo.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/28/2017] [Accepted: 05/26/2017] [Indexed: 11/24/2022]
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Meissner VH, Herkommer K, Marten-Mittag B, Gschwend JE, Dinkel A. Prostate cancer-related anxiety in long-term survivors after radical prostatectomy. J Cancer Surviv 2017; 11:800-807. [DOI: 10.1007/s11764-017-0619-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/05/2017] [Indexed: 01/05/2023]
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15
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16
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Victorson D, Hankin V, Burns J, Weiland R, Maletich C, Sufrin N, Schuette S, Gutierrez B, Brendler C. Feasibility, acceptability and preliminary psychological benefits of mindfulness meditation training in a sample of men diagnosed with prostate cancer on active surveillance: results from a randomized controlled pilot trial. Psychooncology 2016; 26:1155-1163. [DOI: 10.1002/pon.4135] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 01/15/2016] [Accepted: 03/20/2016] [Indexed: 02/04/2023]
Affiliation(s)
- David Victorson
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Osher Center for Integrative Medicine at Northwestern; Northwestern Medicine; Chicago IL USA
| | - Vered Hankin
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - James Burns
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Rebecca Weiland
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Carly Maletich
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | | | - Stephanie Schuette
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Osher Center for Integrative Medicine at Northwestern; Northwestern Medicine; Chicago IL USA
| | - Bruriah Gutierrez
- Department of Medical Social Sciences; Northwestern University Feinberg School of Medicine; Chicago IL USA
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17
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Shah J. Assessment of activity and outcome from a one-stop clinic for men with suspected prostate cancer: Five years’ experience. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415815590527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We have set up a weekly one stop prostate specific antigen (PSA) clinic to evaluate men with suspected prostate cancer (CaP) and report our five years of experience. Methods: Patients with an elevated PSA result, abnormal digital rectal examination, or worrisome symptoms were booked into this clinic. Prostate biopsy was done on the same day, if required. The clinic is run by a single consultant urological surgeon and an advanced nurse practitioner. A database of all patients attending this clinic has been maintained. Results: A total of 729 patients were seen. Rates of non-attendance were low at 2–5 patients each year, and 50.9%–67.1% of patients had a biopsy. Of these, 46.8%–56.1% were diagnosed with CaP, given their results and appropriately treated after multi-disciplinary meeting (MDT) discussion within 15 days. Patients who did not have a cancer diagnosis received a phone call from the consultant at a median time of 2.5 days. Patient and general practitioner (GP) satisfaction levels with this service were high. Conclusions: The one-stop clinic is feasible, efficient in quickly reassuring men without cancer, allows rapid diagnosis and starts treatment within 15 days for those who need it. This clinic reduces waiting times and the number of follow-up visits, and is highly acceptable to patients and GPs.
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Affiliation(s)
- Jyoti Shah
- Department of Urology, Burton Hospitals NHS Foundation Trust, UK
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18
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Jayadevappa R, Chhatre S, Gallo JJ, Wittink M, Morales KH, Bruce Malkowicz S, Lee D, Guzzo T, Caruso A, Van Arsdalen K, Wein AJ, Sanford Schwartz J. Treatment preference and patient centered prostate cancer care: Design and rationale. Contemp Clin Trials 2015; 45:296-301. [PMID: 26435200 DOI: 10.1016/j.cct.2015.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/27/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
Abstract
Prostate cancer is a slow progressing cancer that affects millions of men in the US. Due to uncertainties in outcomes and treatment complications, it is important that patients engage in informed decision making to choose the "optimal treatment". Patient centered care that encompasses informed decision-making can improve treatment choice and quality of care. Thus, assessing patient treatment preferences is critical for developing an effective decision support system. The objective of this patient-centered randomized clinical trial was to study the comparative effectiveness of a conjoint analysis intervention compared to usual care in improving subjective and objective outcomes in prostate cancer patients. We identified preferred attributes of alternative prostate cancer treatments that will aid in evaluating attributes of treatment options. In this two-phase study, in Phase 1 we used mixed methods to develop an adaptive conjoint task instrument. The conjoint task required the patients to trade-off attributes associated with treatments by assessing their relative importance. Phase 2 consisted of a randomized controlled trial of men with localized prostate cancer. We analyzed the effect of conjoint task intervention on the association between preferences, treatment and objective and subjective outcomes. Our conjoint task instrument can lead to a values-based patient-centered decision aid tool and help tailor treatment decision making to the values of prostate cancer patients. This will ultimately improve clinical decision making, clinical policy process, enhance patient centered care and improve prostate cancer outcomes.
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Affiliation(s)
- Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, United States.
| | - Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Joseph J Gallo
- Bloomberg School of Public Health, Johns Hopkins University, United States
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, United States
| | - Knashawn H Morales
- Department of Biostatistics and Epidemiology, University of Pennsylvania, United States
| | - S Bruce Malkowicz
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, United States
| | - David Lee
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Thomas Guzzo
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Adele Caruso
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Keith Van Arsdalen
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, United States
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, United States
| | - J Sanford Schwartz
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States
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19
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Watts S, Leydon G, Eyles C, Moore CM, Richardson A, Birch B, Prescott P, Powell C, Lewith G. A quantitative analysis of the prevalence of clinical depression and anxiety in patients with prostate cancer undergoing active surveillance. BMJ Open 2015; 5:e006674. [PMID: 26002689 PMCID: PMC4442147 DOI: 10.1136/bmjopen-2014-006674] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To quantitatively determine the prevalence of anxiety and depression in men on active surveillance (AS). DESIGN Cross-sectional questionnaire survey. SETTING Secondary care prostate cancer (PCa) clinics across South, Central and Western England. PARTICIPANTS 313 men from a total sample of 426 with a histological diagnosis of PCa currently managed with AS were identified from seven UK urology departments. The mean age of respondents was 70 (51-86) years with the majority (76%) being married or in civil partnerships. 94% of responders were of white British ethnicity. PRIMARY OUTCOME MEASURES The prevalence of clinically meaningful depression and anxiety as assessed by the Hospital Anxiety and Depression Scale (HADS; score ≥8/21). SECONDARY OUTCOME MEASURES Patient demographic data (age, employment, relationship, ethnic and educational status). Each demographic variable was cross-tabulated against patients identified as depressed or anxious to allow for the identification of variables that were significantly associated with depression and anxiety. In order to determine predictors for depression and anxiety among the demographic variables, logistic regression analyses were conducted, with p<0.05 considered as indicating statistical significance. RESULTS The prevalence of clinical anxiety and depression as determined via the HADS (HADS ≥8) was 23% (n=73) and 12.5% (n=39), respectively. Published data from men in the general population of similar age has shown prevalence rates of 8% and 6%, respectively, indicating a twofold increase in depression and a threefold increase in anxiety among AS patients. Our findings also suggest that AS patients experience substantially greater levels of anxiety than patients with PCa treated radically. The only demographic predictor for anxiety or depression was divorce. CONCLUSIONS Patients with PCa managed with AS experienced substantially higher rates of anxiety and depression than that expected in the general population. Strategies to address this are needed to improve the management of this population and their quality of life.
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Affiliation(s)
- Sam Watts
- Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Caroline Eyles
- Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London & Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Brian Birch
- Department of Urology, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Philip Prescott
- Department of Mathematics, University of Southampton, Southampton, UK
| | - Catrin Powell
- Department of Urology, Hampshire Hospitals NHS Trust, Winchester, UK
| | - George Lewith
- Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
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20
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Quero L, Hennequin C. Medical treatment for biochemical relapse after radiotherapy. Cancer Radiother 2014; 18:540-4. [DOI: 10.1016/j.canrad.2014.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 12/31/2022]
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21
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Penedo FJ, Benedict C, Zhou ES, Rasheed M, Traeger L, Kava BR, Soloway M, Czaja S, Antoni MH. Association of stress management skills and perceived stress with physical and emotional well-being among advanced prostrate cancer survivors following androgen deprivation treatment. J Clin Psychol Med Settings 2013; 20:25-32. [PMID: 22739661 DOI: 10.1007/s10880-012-9308-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Advanced prostate cancer (APC) is associated with disruptions that compromise health related quality of life (HRQOL). Treatment often includes androgendeprivation therapy (ADT), which results in a range of side effects (e.g., fatigue, urinary dysfunction) that further impact HRQOL. Despite these challenges, there are limited evaluations of the impact of stress and stress management skills on HRQOL among APC survivors on ADT. This study evaluated relationships among stress, stress management skills, and HRQOL, and it was hypothesized that better stress management skills would relate to greater physical and emotional well-being by mitigating perceived stress levels. Participants (N = 77) were 69.7 years old (SD = 9.8), 18.6 months post-treatment (SD = 17.5), and ethnically diverse (65 % Non-Hispanic White, 13 % Hispanic, 21 % African-American). Measures included the Measure of Current Status for stress management skills, the Perceived Stress Scale for perceived stress, and the Medical Outcomes Study-Short Form (MOS SF-36; physical functioning and emotional well-being subscales) for HRQOL. Direct effects and mediation models were evaluated to determine the relationships between perceived stress, stress management skills, and HRQOL domains, controlling for relevant covariates. Stress management skills and perceived stress were significantly associated with physical functioning (β = .24, p < .05 and β = -.43, p < .01, respectively) and emotional well-being (β = .35, p < .01 and β = -.64, p < .01, respectively). Regression analyses supported the hypothesis that reduced perceived stress mediated the relationship between stress management skills and both physical functioning and emotional well-being. These results demonstrate that one way stress management skills may impact HRQOL is by lessening ongoing perceptions of stress.
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Affiliation(s)
- Frank J Penedo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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22
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Traeger L, Penedo FJ, Benedict C, Dahn JR, Lechner SC, Schneiderman N, Antoni MH. Identifying how and for whom cognitive-behavioral stress management improves emotional well-being among recent prostate cancer survivors. Psychooncology 2013; 22:250-9. [PMID: 21932396 DOI: 10.1002/pon.2074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 07/20/2011] [Accepted: 08/18/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The outcomes of a 10-week cognitive-behavioral stress management (CBSM) group intervention were evaluated in prostate cancer survivors. A model was tested in which CBSM-related improvements in emotional well-being were attained through changes in men's perceptions of their condition, as conceptualized by information processing explanations of self-regulation theory. The model also tested whether life stress and treatment-related side effects moderated intervention effects. METHODS Men treated for localized prostate cancer (n = 257) within the past 18 months were randomized to CBSM or a half-day psycho-educational seminar. At pre-intervention and 12-week follow-up, emotional well-being, illness perceptions, life stress, and sexual and urinary function were assessed using validated questionnaires. RESULTS After controlling for covariates, CBSM participants showed greater improvements in emotional well-being relative to control participants (β = 0.13, p < 0.05). For men reporting higher stress upon study entry, CBSM-related improvements were partially explained by changes in some, but not all, illness perceptions. Sexual and urinary dysfunction did not influence CBSM-related gains. CONCLUSIONS Prostate cancer perceptions may be an important target for enhancing emotional well-being, particularly for men experiencing general life stress. However, interventions that explicitly target mental representations of cancer may be needed to modify perceptions of the disease.
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Affiliation(s)
- Lara Traeger
- Behavioral Medicine Service, Massachusetts General Hospital, One Bowdoin Square, Boston, MA 02114, USA.
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23
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Traeger L, Greer JA, Fernandez-Robles C, Temel JS, Pirl WF. Evidence-Based Treatment of Anxiety in Patients With Cancer. J Clin Oncol 2012; 30:1197-205. [DOI: 10.1200/jco.2011.39.5632] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Anxiety is a dynamic response to perceived threat that is common among patients with cancer and fluctuates at critical points in the disease trajectory. A substantial minority of patients may experience clinically significant anxiety resulting from a range of potential etiologic factors. This review summarizes evidence-based recommendations for treatment of anxiety in oncology settings. Recommendations are based on the nature and time course of anxiety and the results of meta-analyses, systematic reviews, and individual trials in cancer populations. The evidence-based literature supports the use of psychosocial and psychopharmacologic treatments to prevent or alleviate anxiety symptoms. Conclusions are tempered by study heterogeneity and methodologic limitations and a lack of trials that included patients with clinically significant anxiety. In oncology settings, accessibility and acceptability of evidence-based treatments vary, and patients may seek a variety of resources to manage cancer concerns. Treatment planning should incorporate contributing factors to anxiety and patient preferences for psychiatric care.
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Affiliation(s)
- Lara Traeger
- All authors: Massachusetts General Hospital Cancer Center, Boston, MA
| | - Joseph A. Greer
- All authors: Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Jennifer S. Temel
- All authors: Massachusetts General Hospital Cancer Center, Boston, MA
| | - William F. Pirl
- All authors: Massachusetts General Hospital Cancer Center, Boston, MA
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24
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Payne H, Pearcy R. Symptoms and health-related quality of life in castration-resistant prostate cancer: the patient's perspective. JOURNAL OF MEN'S HEALTH 2012. [DOI: 10.1016/j.jomh.2011.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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De Sousa A, Sonavane S, Mehta J. Psychological aspects of prostate cancer: a clinical review. Prostate Cancer Prostatic Dis 2012; 15:120-7. [PMID: 22212706 DOI: 10.1038/pcan.2011.66] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation-liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.
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Abstract
Prostate cancer is biologically and clinically a heterogeneous disease and its imaging evaluation will need to be tailored to the specific phases of the disease in a patient-specific, risk-adapted manner. We first present a brief overview of the natural history of prostate cancer before discussing the role of various imaging tools, including opportunities and challenges, for different clinical phases of this common disease in men. We then review the preclinical and clinical evidence on the potential and emerging role of positron emission tomography with various radiotracers in the imaging evaluation of men with prostate cancer.
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Affiliation(s)
- Hossein Jadvar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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27
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Abstract
The process of PSA screening and subsequent monitoring of PSA levels may represent a great source of emotional distress to patients, the majority of whom are not adequately informed about the screening process and the implications of an abnormal result. The need remains for education of patients on the subject, but no consensus has been reached as to the content of information men should be offered. Helping patients to attribute a different meaning to a potentially stressful event can avoid the development of emotional distress, and physicians can have an important role in this process. Informing patients is essential to allow the development of positive coping styles, and establishing good doctor-patient communication leads to improved compliance and the improvement of patients' psychological wellbeing.
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Affiliation(s)
- Riccardo G V Torta
- Clinical and Oncologic Psychology, San Giovanni Battista University Hospital, Turin, Italy.
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28
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Queenan JA, Feldman-Stewart D, Brundage M, Groome PA. Social support and quality of life of prostate cancer patients after radiotherapy treatment. Eur J Cancer Care (Engl) 2010; 19:251-9. [PMID: 19552729 DOI: 10.1111/j.1365-2354.2008.01029.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- J A Queenan
- Division of Cancer Care and Epidemiology, Queens's Cancer Research Institute, Kingston, ON, Canada
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29
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Traeger L, Penedo FJ, Gonzalez JS, Dahn JR, Lechner SC, Schneiderman N, Antoni MH. Illness perceptions and emotional well-being in men treated for localized prostate cancer. J Psychosom Res 2009; 67:389-97. [PMID: 19837201 DOI: 10.1016/j.jpsychores.2009.03.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 02/25/2009] [Accepted: 03/31/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Emotional adjustment to cancer survivorship may be influenced by how patients interpret treatment side effects and other cancer-related experiences. The current study examined cognitive representations of illness, as conceptualized by the Self-Regulatory Model (SRM), in men treated for localized prostate cancer (PC). More severe PC perceptions were hypothesized to predict poorer emotional well being, particularly among men experiencing greater post-treatment sexual dysfunction or general life stress. METHODS The Perceived Stress Scale, Expanded Prostate Cancer Index Composite, Illness Perception Questionnaire-Revised, and Functional Assessment of Cancer Therapy were administered to 214 men within 18 months of completing treatment for early stage PC. RESULTS Perceptions that PC was less comprehensible, was less likely to be controlled by treatment, and was more likely caused by one's own personality and behaviors remained associated with poorer emotional well being after adjusting for relevant medical and demographic factors. Life stress moderated the relationship between perceived consequences of PC and emotional well-being, such that more severe perceptions of negative consequences predicted poorer emotional well-being only for men experiencing higher life stress. Degree of sexual dysfunction did not moderate any relationships between cancer perceptions and emotional well-being. CONCLUSION Within 18 months of completing treatment for localized PC, more severe perceived consequences of PC were associated with poorer emotional well-being, particularly among men experiencing greater life stress. Interventions that target distortions in illness perceptions may enhance emotional adjustment among the most distressed PC survivors.
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Affiliation(s)
- Lara Traeger
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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30
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Abstract
Prostate cancer poses a major public health problem, particularly in the US and Europe, where it constitutes the most common type of malignancy among men, excluding nonmelanoma skin cancers. The disease is characterized by a wide spectrum of biological and clinical phenotypes, and its evaluation by imaging remains a challenge in view of this heterogeneity. Imaging in prostate cancer can be used in the initial diagnosis of the primary tumor, to determine the occurrence and extent of any extracapsular spread, for guidance in delivery and evaluation of local therapy in organ-confined disease, in locoregional lymph node staging, to detect locally recurrent and metastatic disease in biochemical relapse, to predict and assess tumor response to systemic therapy or salvage therapy, and in disease prognostication (in terms of the length of time taken for castrate-sensitive disease to become refractory to hormones and overall patient survival). Evidence from animal-based translational and human-based clinical studies points to a potential and emerging role for PET, using F-fluorodeoxyglucose as a radiotracer, in the imaging evaluation of prostate cancer.
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31
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Affiliation(s)
- Hossein Jadvar
- From the USC Molecular Imaging Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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32
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Hedestig O, Sandman PO, Widmark A, Rasmussen BH. Meanings of prostate-specific antigen testing as narrated by men with localized prostate cancer after primary treatment. ACTA ACUST UNITED AC 2008; 42:101-9. [PMID: 17907052 DOI: 10.1080/00365590701571530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To illuminate the meanings of prostate-specific antigen (PSA) testing as narrated by men with localized prostate cancer (LPC) after primary treatment. MATERIAL AND METHODS Fifteen men were interviewed in their homes. The narrative interview text was analyzed using a phenomenological hermeneutic method inspired by the philosophy of Paul Ricoeur. RESULTS Life after treatment for LPC means feeling unsafe because of being affected by a life-threatening and unpredictable disease, characterized by a lack of early signs of progression. In this situation, PSA testing is ascribed as providing a sense of control to enable one to achieve a feeling of safety. Thus one meaning of PSA testing is receiving a message about the status of the body; another is a tense waiting related to fear of the results. A low, stable PSA value is interpreted as a sense of being safe based on confidence in the PSA tests and a sense of having control over the LPC via regular PSA testing. A rising value of the PSA blood test is understood as an indication of progression of the disease, but confidence in PSA testing also means that when the PSA value rises there is a sense of catching the cancer in good time. CONCLUSIONS The comprehensive understanding of the meaning of PSA testing can be understood in terms of a lifeline to cling to when wondering whether the cancer is still in progress in the body or whether the treatment has been curative. This lifeline creates a feeling of security in a post-treatment life situation which is experienced as being unsafe.
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Abstract
This investigation evaluated the psychological needs of men (n = 28) with biochemical recurrence of prostate cancer. A mixed qualitative-quantitative approach was employed. The qualitative component consisted of focus groups and the quantitative component included administration of standardized measures assessing quality of life (QOL), anxiety, and mood. Participants reported substantial anxiety and other negative moods secondary to prostate cancer. Responses form the quantitative instruments suggest participants experience significant health problems specific to prostate cancer, while their general QOL is superior to other chronically ill medical populations. In contrast to the qualitative data, participants rated their mood as favorable on the quantitative measures. Data were used to guide development of a novel QOL intervention.
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34
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Awsare NS, Green JSA, Aldwinckle B, Hanbury DC, Boustead GB, McNicholas TA. The measurement of psychological distress in men being investigated for the presence of prostate cancer. Prostate Cancer Prostatic Dis 2008; 11:384-9. [DOI: 10.1038/pcan.2008.21] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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35
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Irani J, Celhay O, Hubert J, Bladou F, Ragni E, Trape G, Doré B. Continuous versus six months a year maximal androgen blockade in the management of prostate cancer: a randomised study. Eur Urol 2008; 54:382-91. [PMID: 18339475 DOI: 10.1016/j.eururo.2008.02.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate systematically interrupted androgen suppression (SIAS) 6 mo a year compared with continuous androgen suppression (CAS) in prostate cancer treatment. PATIENTS AND METHODS All patients underwent maximal androgen blockade for 6 mo. Then, depending on the randomisation arm, they continued (CAS) or stopped their treatment for 6 mo before they resumed it a year later and so on (SIAS). Primary end points were patient's health-related quality of life (HQOL) and time to progression. Secondary end points were cancer-specific and overall survival. Progression was defined by a clinical event or PSA value exceeding double the value obtained at the end of the first 6 mo of therapy. RESULTS Sixty-two patients were randomised to CAS and 67 to SIAS. There were no significant differences between groups at baseline. Androgen suppression was associated with HQOL deterioration except for an improvement in urinary symptoms. The 6-mo off-therapy period was not long enough to regain normal testosterone values. There was no difference in HQOL scores between CAS and SIAS except that men in the latter group reported a greater need for painkillers but a better ability to have an erection. Progression occurred in 62 patients (48.1%) with no significant difference between CAS and SIAS with a mean follow-up of 44.8 mo. Death occurred in 41 patients and specific death in 19 patients (10% and 19% of the CAS and SIAS groups, respectively). CONCLUSIONS Although patients in the SIAS group were maintained off-therapy 50% of the time, insufficient testosterone recovery in this group likely explains why differences between the two groups were moderate or absent with regards to HQOL and survival, respectively.
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Affiliation(s)
- Jacques Irani
- Department of Urology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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36
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Namiki S, Saito S, Tochigi T, Ioritani N, Terai A, Arai Y. Impact of salvage therapy for biochemical recurrence on health-related quality of life following radical prostatectomy. Int J Urol 2007; 14:186-91. [PMID: 17430252 DOI: 10.1111/j.1442-2042.2007.01610.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the impact of salvage therapy for prostate-specific antigen (PSA) recurrence on the health-related quality of life (HRQOL) of patients after radical retropubic prostatectomy (RP). METHODS Between January 2000 and December 2003, a total of 249 patients who underwent RP were available for 2-year follow up. Of the respondents, 203 men did not show evidence of recurrence (group A), and 46 men received salvage hormonal therapy and/or radiotherapy after RP because of a rise in PSA (group B). The general and prostate-target HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles Prostate Cancer Index, respectively. Patients completed the HRQOL instruments by mail at baseline and at 24 months after RP. RESULTS All of the patients completed both questionnaires. At baseline no significant differences were found between the two groups in any of the HRQOL domains. There were significant improvements in mental health and social function for the patients without biochemical recurrence postoperatively. Repeated measure anova revealed significantly different patterns of alteration in several general HRQOL domains among the treatment groups. The urinary and bowel domains were equivalent between the two treatment groups at baseline and 24 months after RP. The patients treated with salvage hormonal therapy tended to show delayed recovery of sexual function. CONCLUSION Using a self-administered questionnaire, biochemical recurrence following RP was found to impose a substantial burden in patients with localized prostate cancer.
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Affiliation(s)
- Shunichi Namiki
- Department of Urology, Tohoku University Graduate School of Medicine, 1-1 Seuryomachi, Aoba-ku, Sendai 980-8574, Japan.
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Streszczenie. Rep Pract Oncol Radiother 2007. [DOI: 10.1016/s1507-1367(07)70955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Clark JA, Talcott JA. Confidence and Uncertainty Long After Initial Treatment for Early Prostate Cancer: Survivors' Views of Cancer Control and the Treatment Decisions They Made. J Clin Oncol 2006; 24:4457-63. [PMID: 16983114 DOI: 10.1200/jco.2006.06.2893] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The many years most men diagnosed with early prostate cancer live after diagnosis allow evolving assessments of their cancer control and their treatment choices, but little is known of these outcomes or the factors that influence them. Patients and Methods We surveyed an established, prospective cohort that had initiated treatment for early prostate cancer 4 to 8 years previously. We assessed perceived cancer control, quality of treatment decisions, and other domains of quality of life, along with treatment-related urinary, bowel, and sexual dysfunction. Results Most men reported high confidence in cancer control and their treatment decisions, but many reported misgivings about one or both. The diagnostic, treatment, and quality-of-life factors associated with these two outcomes were distinct. Perceived cancer control was lower among those with adverse medical factors: higher pretreatment Gleason scores, subsequent rises in prostate-specific antigen (PSA), and secondary androgen ablation therapy. Confidence in treatment decisions was unrelated to these factors and was higher in men who opted for radical prostatectomy or brachytherapy, reported close attention to current PSA, had high masculine self-esteem and little distress from sexual dysfunction, and were married. Conclusion Although perceptions of cancer control and the quality of their treatment decisions are linked, men can distinguish between these two outcomes. They incorporate objective indicators of high risk and adverse outcomes when assessing their cancer control; confidence in treatment decisions represents a more complex psychosocial adjustment to the persistent uncertainty that originates with their diagnosis.
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Affiliation(s)
- Jack A Clark
- Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, USA.
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Roth A, Nelson CJ, Rosenfeld B, Warshowski A, O'Shea N, Scher H, Holland JC, Slovin S, Curley-Smart T, Reynolds T, Breitbart W. Assessing anxiety in men with prostate cancer: further data on the reliability and validity of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). PSYCHOSOMATICS 2006; 47:340-7. [PMID: 16844894 DOI: 10.1176/appi.psy.47.4.340] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Identifying which men with prostate cancer might benefit from mental health treatment has proven to be a challenging task. The authors developed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) in order to facilitate the identification of prostate cancer-related anxiety. A revised version of this scale was tested in a more clinically varied population. Ambulatory men with prostate cancer (N=367) completed a baseline assessment packet that included the MAX-PC and other psychosocial questionnaires. The MAX-PC showed high internal consistency and concurrent and discriminant validity. Factor analysis identified three distinct factors for the MAX-PC that corresponded to the intended subscales (General Prostate Cancer Anxiety, PSA (prostate-specific antigen) Anxiety, and Fear of Recurrence). PSA levels were not correlated with anxiety overall; however, anxiety was significantly higher among patients whose PSA levels were changing (i.e., rising, falling, and unstable), versus those with stable PSA levels. Also, in a multivariate analysis, the change in PSA levels was a significant predictor of MAX-PC scores, but not Hospital Anxiety and Depression Scale (HADS) scores. These results indicate that the MAX-PC is a valid and reliable measure of anxiety that assesses aspects of anxiety unique to men with prostate cancer, and it may provide a more sensitive measure of anxiety than the HADS for this population.
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Affiliation(s)
- Andrew Roth
- Dept. of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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Scales CD, Curtis LH, Norris RD, Schulman KA, Albala DM, Moul JW. Prostate Specific Antigen Testing in Men Older Than 75 Years in the United States. J Urol 2006; 176:511-4. [PMID: 16813879 DOI: 10.1016/j.juro.2006.03.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE Although there is general agreement that men older than 75 years are unlikely to benefit from prostate specific antigen testing, patient reported testing rates in these patients exceed 30%. We examined physician reported PSA testing in elderly men, and physician and practice characteristics associated with testing. MATERIALS AND METHODS Using the 1999 to 2002 National Ambulatory Medical Care Survey, a nationally representative sample of outpatient visits to nonfederal office based physicians, we measured rates of prostate specific antigen testing by age group in men without prostate cancer who were 40 years or older and who visited outpatient family medicine, internal medicine or urology clinics. RESULTS An estimated 42.3 million prostate specific antigen tests were performed from 1999 to 2002, of which 5.91 million (14.0%) were performed in men older than 75 years. The population based testing rate was 6.1% in patients 40 to 49-year-old, 26.0% in patients 50 to 75-year-old and 27.8% in patients older than 75 years. Urologists performed 35.4% of prostate specific antigen tests in men older than 75 years. Controlling for sociodemographic variables physicians with a laboratory on site were more likely to perform a prostate specific antigen test (OR 1.35, 95% CI 1.07 to 1.71). In men older than 75 years the odds of prostate specific antigen testing were 1.58 times higher (95% CI 1.01 to 2.50) in practices with a laboratory on site. CONCLUSIONS Up to a third of men older than 75 years undergo prostate specific antigen testing despite an average life expectancy of less than 10 years. Physician and practice characteristics are associated with prostate specific antigen PSA testing.
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Affiliation(s)
- Charles D Scales
- Duke Prostate Center, Division of Urology, Department of Surgery and Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27710, USA
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Penson D, Moul J, Gandhi S, Newling D. Use of prostate-specific antigen in the follow-up of patients with localized prostate cancer: results of a nationwide survey of urologists. Urology 2006; 68:80-4. [PMID: 16777198 DOI: 10.1016/j.urology.2006.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 11/19/2005] [Accepted: 01/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To perform a nationwide survey of urologists' opinions and behavior regarding the use of prostate-specific antigen (PSA) in prostate cancer follow-up and secondary treatment. METHODS A random sample of 300 urologists was interviewed. Content areas included defining recurrence in prostate cancer, factors that influence initiation of secondary treatment in this setting, and need for additional clinical trial information in recurrent prostate cancer. RESULTS Seventy-eight percent of urologists indicated that absolute PSA levels were of high or very high importance when making follow-up decisions. When defining a rising PSA level, 83% of urologists surveyed use the American Society for Therapeutic Radiology and Oncology definition of failure. An additional 78% use PSA doubling time. When asked about the importance of rapidly reducing PSA levels after recurrence, 61% said it was of high or very high importance to them, but 81% said it was of high or very high importance to their patients. CONCLUSIONS Results from the current study indicate that urologists consider PSA failure to be an important outcome in patients with prostate cancer. Researchers and policy makers need to consider this outcome when designing studies of prostate cancer.
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Affiliation(s)
- David Penson
- Norris Comprehensive Cancer Center, Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA.
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Palmer C, Pratt J, Basu B, Earl H. A study to evaluate the use of CA125 in ovarian cancer follow-up: A change in practice led by patient preference. Gynecol Oncol 2006; 101:4-11. [PMID: 16445969 DOI: 10.1016/j.ygyno.2005.11.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 11/19/2005] [Accepted: 11/30/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the use of CA125 in the follow-up of women with epithelial ovarian cancer in the Cambridge Gynaecologic Oncology Centre. To institute changes depending on patients' preferences. METHODS A patient questionnaire was developed on follow-up, CA125 estimation and patient education in epithelial ovarian cancer and CA125. Initially, 100 patients were evaluated, and a change in practice was instituted. This was re-evaluated using the same patient population. RESULTS 22/22 patients in clinic, and 68/78 patients who received the questionnaire by post, completed and returned it (n = 90). 81% wanted CA125 results available at clinic follow-up visits, with 82% willing to have the blood test done at their GP surgery before attending outpatients. CA125 follow-up practice was changed accordingly. This change was re-evaluated. A second questionnaire was sent to 35 surviving patients from the first cohort. 31/35 (90%) responses were received. Five patients were either no longer on follow-up, being > or =5 years from completing their original treatment or were being monitored elsewhere, leaving an 87% response rate (26/30). 92.3% felt that having CA125 results available in clinic had enhanced the quality of their follow-up. Patient education and basic understanding of CA125 also improved, with 88.5% aware of its role. CONCLUSIONS The availability of CA125 results when patients attend for routine follow-up has improved their overall management in our clinics. It has reduced patient and physician anxiety and unsatisfactory out-of-clinic telephone communication. We recommend this change of practice to all Gynaecologic Oncology Centres engaged in active routine follow-up of their patients with epithelial ovarian cancer.
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Affiliation(s)
- Cheryl Palmer
- Department of Oncology, Cambridge Gynae-Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 193, Hills Road, Cambridge CB2 2QQ, UK.
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Dale W, Bilir P, Han M, Meltzer D. The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer 2005; 104:467-78. [PMID: 15959911 PMCID: PMC3010360 DOI: 10.1002/cncr.21198] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although the impact of anxiety on patients with some types of cancer is well recognized, to the authors knowledge its impact on patients with prostate carcinoma has not been studied as thoroughly. The authors conducted a systematic review of the medical literature for high-quality articles that quantified anxiety levels in men with prostate carcinoma and identified 29 articles. Using the clinical timeline of prostate carcinoma to organize the articles, cross-sectional studies that reflected anxiety prevalence in populations and longitudinal studies that reflected changes in anxiety over time were identified. Anxiety appeared to fluctuate over the clinical timeline in response to stressors and uncertainty (such as at the time of screening and/or biopsy), rising before these times and falling afterward. Although anxiety levels in men age > 55 years who were at risk for prostate carcinoma were modest (10-15%), multiple studies found that these levels were substantially higher in men who presented for screening (> 50%), and "seeking peace of mind" was the motivation cited most frequently for pursuing screening. Most studies demonstrated a significant decrease in anxiety levels after a normal screening or biopsy result, although the proportion of men who remained anxious afterward did not fall to baseline levels (20-36%). Men who presented for prostate-specific antigen monitoring after treatment had elevated anxiety levels at the time of testing (23-33%). Many years after therapy for localized disease, anxiety levels were lower after prostatectomy (23%) compared with the levels after watchful waiting (31%).
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Affiliation(s)
- William Dale
- Department of Medicine, Section of Geriatrics, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
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Kwan W, Pickles T, Duncan G, Liu M, Agranovich A, Berthelet E, Keyes M, Kim-Sing C, Morris WJ, Paltiel C. PSA failure and the risk of death in prostate cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys 2004; 60:1040-6. [PMID: 15519773 DOI: 10.1016/j.ijrobp.2004.03.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Revised: 03/01/2004] [Accepted: 03/08/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the relationship between prostate-specific antigen (PSA) failure and cause-specific and overall survival in prostate cancer patients treated with radical radiotherapy. METHODS AND MATERIALS Patients with and without PSA failure were compared with respect to overall survival and cause-specific survival in a cohort of 1786 patients. The relationship between PSA failure and survival was further investigated among six subgroups defined by three tumor risk groups (high, intermediate, and low risk based on T stage, Gleason score, and presenting PSA) and two age groups (<75 years and >/=75 years). RESULTS The 5-year overall survival among patients who had PSA failure was 79.5% vs. 87.5% among patients who had not failed (p = 0.0003). The corresponding 5-year cause-specific survival was 84.4% vs. 99.0% (p <0.0001). When the six subgroups are considered separately, PSA failure was associated with a worse cause-specific survival in the groups with intermediate- and high-risk disease. PSA failure was only associated with a worse overall survival in one subgroup: patients younger than 75 with high-risk disease. Deaths from nonprostate causes made the survival curves of patients with and without PSA failure in the other subgroups almost identical. CONCLUSION PSA failure in prostate cancer patients treated with radiotherapy was associated with a poorer overall survival, which is seen mainly in younger patients with high-risk disease.
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Affiliation(s)
- Winkle Kwan
- Radiation Therapy Program, Fraser Valley Centre, British Columbia Cancer Agency, Surrey, British Columbia, Canada.
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Kim-Sing C, Pickles T. Intervention after PSA failure: examination of intervention time and subsequent outcomes from a prospective patient database. Int J Radiat Oncol Biol Phys 2004; 60:463-9. [PMID: 15380580 DOI: 10.1016/j.ijrobp.2004.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Revised: 03/02/2004] [Accepted: 03/08/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate timing of intervention for solitary biochemical relapse following external beam radiation therapy (EBRT) for localized prostate cancer, and to assess the impact on survival. METHODS AND MATERIALS Of 1499 men treated with EBRT from 1994 to 2000, 544 men had prostate-specific antigen (PSA) relapse by the Vancouver Criteria. Patients with near-simultaneous clinical relapse (n = 79) were excluded, leaving 465 for analysis. Pretreatment prognostic factors, the time that biochemical relapse was realized (trigger PSA time), and postrelapse doubling time (PSAdt) were examined for effect on the timing of intervention and cause-specific survival (CSS). RESULTS Median actuarial time from trigger-PSA time to intervention was 30 months. The only factor associated with early intervention on multivariate analysis (MVA) was faster PSAdt (p < 0.0001). Not significant were initial PSA, Gleason score, T stage, or adjuvant androgen ablation use or duration. Seventy-five percent of interventions occurred with PSAdt faster than 12 months. The 5-year CSS was 89%. Faster PSAdt (p = 0.0007), higher Gleason score (p = 0.018), and earlier intervention (p = 0.0006) were significantly associated with increased prostate cancer death on MVA. The 5-year CSS is 19% where the PSAdt was <3 months, 84% where 3-6 months, 93% where 6-12 months, and 98% where >12 months (p < 0.0001). CONCLUSIONS Men with a biochemical relapse post-EBRT with PSAdt >1 year had excellent 5-year CSS (98%). Rapid PSAdt is associated with increased mortality on MVA. The association of earlier intervention with increased mortality may be due to the selection of those with occult metastasis for early intervention.
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Abstract
Population-based screening seems to be a common-sense strategy for controlling cancer, but recent reports have raised controversy concerning the benefits of common screening procedures. Intense efforts to develop and evaluate novel screening technologies are underway; however, effective use of any screening method must take into account any underlying biological considerations. What are these biological issues, and what challenges do clinicians face in screening for common cancers?
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Affiliation(s)
- Michael N Pollak
- Programs of Cancer Prevention and Cancer Genetics, McGill University, Montreal, Quebec, Canada H3T 1E2.
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