Fear of cancer recurrence and PSA anxiety in patients with prostate cancer: a systematic review

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.

Depression, Anxiety, and Their Association to Health-Related Quality of Life in Men Commencing Prostate Cancer Treatment at Tertiary Hospitals in Cape Town, South Africa

“…Similar findings were noted in a recent systematic review in CaP patients done by James et al, 2022. 45 About a third of the men had trait anxiety suggesting a predisposition to anxiety. 46 Our values for depression and anxiety correspond well with the meta-analysis done by Watts 2014.…”

Mental wellbeing and quality of life in prostate cancer (MIND-P): Protocol for a multi-institutional prospective cohort study

“…Primary study outcomes collected within questionnaires included validated psychometric measures for mental wellbeing post prostate cancer diagnosis. Important mental wellbeing outcomes were defined through multiple extensive and systematic searches of the existing literature due to variable current definitions [ 7 , 9 , 10 ]. This selected five mental wellbeing constructs of interest which will be included within the overall primary outcome of ‘mental wellbeing’:…”

“…This includes fear of cancer recurrence (FCR) or progression which has previously been labelled as one of the most common unmet cancer needs [ 8 ]. Along with Prostate-Specific Antigen (PSA) Anxiety, FCR is a prevalent issue in patients with prostate cancer [ 9 ]. Furthermore, issues surrounding masculinity, masculine-self-esteem and body image appear important in this population and represent constructs which assess the concept of self-worth representing the view of our body and mind and how it is perceived by others around us [ 10 ].…”

Undergoing radical treatment for prostate cancer and its impact on wellbeing: A qualitative study exploring men’s experiences

“…When considering mental wellbeing for patients with prostate cancer, further issues exist beyond anxiety and depression which are often overlooked. Fear of cancer recurrence and PSA Anxiety is common and is associated with functional impairment, reduced quality of life and behaviours demonstrated to seek reassurance [12,13]. This has also been highlighted as one of the most common unmet cancer needs [14].…”