Department of Urology, University of Illinois College of Medicine, Chicago, IL, USA.
Division of Urology, Department of Surgery and the Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Prostate Cancer Prostatic Dis. 2021 Jun;24(2):335-340. doi: 10.1038/s41391-020-00279-z. Epub 2020 Sep 8.
Active surveillance (AS) provides appropriate prostate cancer (PCa)-specific survival while minimizing morbidity, but underlying worry of PCa can generate anxiety. The aim of the study is to evaluate anxiety levels in men on AS and how anxiety relates to disease characteristics and treatment decision-making.
A retrospective analysis was conducted using all 302 subjects from the Reduction by Dutasteride of clinical progression Events in Expectant Management (REDEEM) study. Prostate biopsies were obtained at 18 and 36 months. Anxiety was measured at baseline and 3, 6, 12, 18, and 36 months post-randomization using the MAX-PC (Memorial general anxiety scale for PCa) questionnaire. Univariable and multivariable analysis of the association of disease aggressiveness (PSA levels, percentage of positive cores, and maximum core involvement) and anxiety levels were performed. Cox regression was used to analyze time to progression to discontinuation of active surveillance as a function of baseline anxiety.
Overall, MAX-PC scores decreased from moderate at baseline with slight increases after receiving PSA results at 18 months, followed by more decline. Percentage of positive cores was associated with baseline anxiety (P = 0.02). The association remained when controlling for age, race, number of cores sampled, body mass index, prostate volume, and maximum core length (P = 0.003). In univariable and multivariable analysis, baseline anxiety was not significantly associated with time to progression to discontinuation of active surveillance.
In evaluating the natural history of anxiety levels among patients with prostate cancer undergoing active surveillance, there was a decline of anxiety levels over time, with increases after receiving PSA results. Moreover, we found that disease aggressiveness measured by percentage of positive biopsy cores was associated with baseline levels of anxiety. However, anxiety had no impact on clinical or therapeutic progression.
主动监测（AS）在最大限度地减少发病率的同时提供了适当的前列腺癌（PCa）特异性生存，但对 PCa 的潜在担忧会产生焦虑。本研究旨在评估接受 AS 治疗的男性的焦虑水平，以及焦虑与疾病特征和治疗决策的关系。
使用来自降低多沙唑嗪对期待管理中临床进展事件（REDEEM）研究的 302 名受试者进行回顾性分析。18 个月和 36 个月时进行前列腺活检。在随机分组后 3、6、12、18 和 36 个月时，使用 MAX-PC（前列腺癌的纪念总焦虑量表）问卷测量焦虑程度。使用单变量和多变量分析疾病侵袭性（PSA 水平、阳性核心比例和最大核心受累）与焦虑水平的关系。使用 Cox 回归分析作为基线焦虑的函数来分析进展为主动监测停药的时间。
总体而言，MAX-PC 评分从基线时的中度开始，在 18 个月时接受 PSA 结果后略有升高，随后再次下降。阳性核心比例与基线焦虑相关（P=0.02）。在控制年龄、种族、采样核心数量、体重指数、前列腺体积和最大核心长度后，这种关联仍然存在（P=0.003）。在单变量和多变量分析中，基线焦虑与进展为主动监测停药的时间无显著相关性。
在评估接受主动监测的前列腺癌患者焦虑水平的自然史时，焦虑水平随时间下降，在接受 PSA 结果后增加。此外，我们发现，通过阳性活检核心比例测量的疾病侵袭性与基线焦虑水平相关。然而，焦虑对临床或治疗进展没有影响。
