Emotional distress is associated with an increased likelihood of opting for surgery among men with localized prostate cancer, a study published in The Journal of Urology has shown.1

Patients living with cancer often experience anxiety and distress, which may impact quality of life and treatment decisions. Therefore, researchers sought to determine if greater emotional distress among men with clinically localized prostate cancer, particularly those with low risk disease, have a higher likelihood of opting for more aggressive therapy such as surgery rather than radiation or active surveillance.

For the study, investigators enrolled 1531 patients from 2 academic and 3 community facilities. Of those, 36% had low risk, 49% had intermediate risk, and 15% had high risk. Emotional distress was evaluated shortly after cancer diagnosis and after men made their treatment decision using the Distress Thermometer.

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Results showed that 48%, 27%, and 24% chose surgery, radiation, and active surveillance, respectively.

Researchers found that patients who had a greater level of emotional distress at the time of diagnosis were more likely to opt for surgery over active surveillance (P =.02).

In addition, men who were more emotionally distressed close to the time of their treatment decision had a higher likelihood of choosing surgery over active surveillance (P <.001) or surgery over radiotherapy (P =.001).

This pattern was similarly observed among patients with low risk disease.

The findings ultimately suggest that emotional distress may prompt men with low risk prostate cancer to choose more aggressive treatment. Clinicians should address emotional distress experienced by patients prior to, and during treatment decision-making, to reduce a barrier that may be negatively impacting the uptake of active surveillance.


1. Orom H, Underwood W III, Biddle C. Emotional distress increases the likelihood of receiving surgery among men with localized prostate cancer. J Urol. 2016 Aug 6. doi: 10.1016/j.uro.2016.08.007. [Epub ahead of print]