van den Bergh Roderick C N, Essink-Bot Marie-Louise, Roobol Monique J, Wolters Tineke, Schröder Fritz H, Bangma Chris H, Steyerberg Ewout W
Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Cancer. 2009 Sep 1;115(17):3868-78. doi: 10.1002/cncr.24446.
Patients on active surveillance (AS) for early prostate cancer (PC) may experience feelings of anxiety and distress while living with "untreated" cancer. In this study, these feelings were quantified, and their associations with various psychologic, medical, demographic, and decision-related factors were assessed.
Men with recently diagnosed PC who participated in a prospective protocol-based AS program (the Prostate Cancer Research International: Active Surveillance study [PRAIS]) received a questionnaire (N = 150). Scores concerning decisional conflict (the Decisional Conflict Scale), depression (the Center for Epidemiologic Studies Depression Scale), generic anxiety (the abridged State-Trait Anxiety Inventory), and PC-specific anxiety (the Memorial Anxiety Scale for Prostate Cancer) were compared with reference values and the literature. Associations with scores on physical health (the Medical Outcomes Study 12-item short-form Physical Component Summary), personality (the Eysenck Personality Questionnaire), shared decision-making, knowledge of PC, and demographic and medical parameters were determined with univariate and multivariate linear regression analyses.
The questionnaire response rate was 86% (129 of 150 men). Of all respondents, 81%, 92%, 83%, and 93% scored better than reference values for clinically significant uncertainty regarding the treatment decision, depression, generic anxiety, and PC-specific anxiety, respectively. Scores were comparable to or more favorable than those of men (reported in literature) who underwent other treatments for localized PC. In multivariate analysis, the following associations emerged: a perceived important role of the physician in shared decision-making was associated with higher decisional conflict, better physical health was associated with lower depression, neurotic personality was associated with higher depression and with generic and PC-specific anxiety, and higher prostate-specific antigen level was associated with higher PC-specific anxiety.
Men on protocol-based AS mainly reported favorable levels of anxiety and distress. A neurotic personality score was associated with unfavorable effects. These findings may help to optimize patient selection for AS or to select men for supportive measures.
接受早期前列腺癌（PC）主动监测（AS）的患者在患有“未治疗”癌症的情况下可能会感到焦虑和痛苦。在本研究中，对这些感受进行了量化，并评估了它们与各种心理、医学、人口统计学和决策相关因素的关联。
参与一项基于前瞻性方案的AS项目（国际前列腺癌研究：主动监测研究[PRAIS]）的近期诊断为PC的男性接受了问卷调查（N = 150）。将关于决策冲突（决策冲突量表）、抑郁（流行病学研究中心抑郁量表）、一般焦虑（简化的状态-特质焦虑量表）和PC特异性焦虑（前列腺癌纪念焦虑量表）的得分与参考值和文献进行比较。通过单变量和多变量线性回归分析确定与身体健康得分（医学结果研究12项简短形式身体成分总结）、人格（艾森克人格问卷）、共同决策、PC知识以及人口统计学和医学参数的关联。
问卷回复率为86%（150名男性中的129名）。在所有受访者中，分别有81%、92%、83%和93%在治疗决策的临床显著不确定性、抑郁、一般焦虑和PC特异性焦虑方面的得分优于参考值。这些得分与接受局限性PC其他治疗的男性（文献报道）相当或更有利。在多变量分析中，出现了以下关联：医生在共同决策中被认为的重要作用与更高的决策冲突相关，更好的身体健康与更低的抑郁相关，神经质人格与更高的抑郁以及一般和PC特异性焦虑相关，更高的前列腺特异性抗原水平与更高的PC特异性焦虑相关。
基于方案进行AS的男性主要报告焦虑和痛苦水平良好。神经质人格得分与不良影响相关。这些发现可能有助于优化AS的患者选择或为男性选择支持性措施。
