Urology Service, Department of Surgery and Department of Epidemiology and Biostatistics (MA, AV), Memorial Sloan Kettering Cancer Center, New York, New York.
Urology Service, Department of Surgery and Department of Epidemiology and Biostatistics (MA, AV), Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2018 Dec;200(6):1250-1255. doi: 10.1016/j.juro.2018.06.013. Epub 2018 Jun 7.
Active surveillance is the preferred management of low risk prostate cancer. Cancer specific anxiety during active surveillance remains under studied. We evaluated long-term anxiety in men on active surveillance to determine whether interventions must be tailored to improve adherence.
A total of 413 men enrolled in active surveillance at a single tertiary care center completed quality of life surveys as part of routine care. A modified version of the MAX-PC (Memorial Anxiety Scale for Prostate Cancer) was used to determine cancer specific anxiety. Generalized estimating equations were applied to evaluate the association between anxiety and the duration on surveillance. Additionally, we examined associations between anxiety and patient age, marital status, Gleason score, the number of positive cores, family history and overall health.
Median patient age was 61 years, median prostate specific antigen at diagnosis was 4.4 ng/ml and 95% of the patients had Gleason 6 disease. Median time from the initiation of active surveillance to the last survey was 3.7 years. There was a 29% risk of reporting cancer specific anxiety within year 1. Anxiety significantly decreased with time (OR 0.87, 95% CI 0.79-0.95, p = 0.003). Pathological and demographic characteristics were not associated with anxiety after adjusting for time on surveillance.
In men undergoing active surveillance we observed a moderate risk of cancer specific anxiety which significantly decreases with time. Those considering conservative management can be informed that, although it is common to experience some anxiety initially, most patients rapidly adjust and report low anxiety levels within 2 years.
主动监测是低危前列腺癌的首选治疗方法。在主动监测期间，癌症特异性焦虑仍然研究不足。我们评估了正在接受主动监测的男性的长期焦虑，以确定是否必须进行干预以提高依从性。
共有 413 名在一家三级保健中心接受主动监测的男性完成了作为常规护理一部分的生活质量调查。使用改良的 MAX-PC（前列腺癌记忆焦虑量表）来确定癌症特异性焦虑。广义估计方程用于评估焦虑与监测持续时间之间的关联。此外，我们还检查了焦虑与患者年龄、婚姻状况、Gleason 评分、阳性核心数、家族史和整体健康之间的关系。
患者中位年龄为 61 岁，中位前列腺特异性抗原诊断值为 4.4ng/ml，95%的患者为 Gleason 6 级疾病。从开始主动监测到最后一次调查的中位时间为 3.7 年。第一年报告癌症特异性焦虑的风险为 29%。焦虑随时间显著降低（OR 0.87，95%CI 0.79-0.95，p = 0.003）。在调整监测时间后，病理和人口统计学特征与焦虑无关。
在接受主动监测的男性中，我们观察到癌症特异性焦虑的风险适中，且随着时间的推移显著降低。那些考虑保守治疗的人可以得知，尽管最初会经历一些焦虑，但大多数患者会迅速调整，并在 2 年内报告低水平的焦虑。
