The measurement of psychological distress in men being investigated for the presence of prostate cancer

Abstract

High levels (450%) of anxiety are reported in patients undergoing screening for prostate cancer, which may affect health-related quality of life. We aimed to determine the level and prevalence of anxiety and depression and to identify those aspects of the diagnostic pathway that induce the most stress in men being investigated for prostate cancer. A total of 159 prostate-specific antigenunscreened men undergoing a transrectal ultrasound-guided biopsy of the prostate (TRUS-B) completed two questionnaires, prior to their biopsy and before receiving results, containing the Hospital Anxiety and Depression Scale (HADS) and a 10-point Visual Analogue Scale (VAS). Median scores and prevalence of anxiety (4-5, 4-7%) and depression (1-2, 1.4%) respectively were low for both questionnaires. Waiting for biopsy results received the highest median VAS score (6) and was the most stressful event in 65% of men. There is a low incidence of clinically significant anxiety and depression in men being investigated for prostate cancer but questionnaires such as HADS identify patients with psychological distress who may benefit from early counselling. Uncertainty about the future while awaiting biopsy results after TRUS-B seems to be the most stressful event in patients' lives and minimizing this wait should help optimize patient care.

Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result

“…In an earlier longitudinal study of men being screened for prostate cancer, Gustafsson et al (1995) reported that cortisol level (indicating the degree of emotional stress) was highest immediately before being informed of the biopsy result, although levels decreased somewhat 2 weeks later in those who received a benign biopsy result. Other studies have concluded that testing for prostate cancer had little or no effect on men's psychological health (Brindle et al, 2006;Awsare et al, 2008). These studies relied on the Hospital Anxiety and Depression Scale (HADS) (Zigmond and Snaith, 1983), which was designed to detect clinical cases of anxiety and depression.…”

“…These results, particularly that high levels of distress may be encountered by some men, should be included in information presented to men by GPs before they consent to receiving a test. For men undergoing testing, whether as part of screening, or in primary or secondary care, the concomitant collection of POMS and IES data could be used to identify men who are experiencing tension-anxiety and early distress symptoms at the time of the PSA test, and thus identify those who might benefit from additional support and information to prevent this developing into distress later on (see also Essink-Bot et al, 1998;Awsare et al, 2008).…”

Psychological impairment in patients urgently referred for prostate and bladder cancer investigations: the role of trait emotional intelligence and perceived social support

“…Worry was assessed using two 100-mm visual analogue scales (VAS) [4]. The extremities were anchored at 'not worried at all' and 'extremely worried' in relation to the appointment and results of the appointment.…”

“…Emerging research has also found increased anxiety during earlier stages of the prostate cancer pathway when patients are undergoing prostatic investigation in response to positive screening tests [3] or referrals due to elevated prostate-specific antigen tests or abnormal digital rectal exams [4]. This suggests that some patients in the pre-diagnostic stage may experience anxiety as a result of the processes involved in this part of the diagnostic pathway.…”

Injuries before and after diagnosis of cancer: nationwide register based study

“…It is, however, unknown whether the risk of injuries is also increased during the time period before the diagnosis. Evidence suggests that the diagnostic process of cancer entails severe emotional distress, regardless of the eventual result, [13][14][15][16][17] and could therefore increase the risk of non-iatrogenic injuries (intentional or unintentional). To this end, we analysed the risks of both iatrogenic and non-iatrogenic injuries during the weeks before and after diagnosis using a nationwide study sample in Sweden.…”