Ryan Wong, BS: No financial relationships to disclose
Introduction/Purpose: Many men with Gleason Grade (GG) 3+3 prostate cancer (PCa) are classified as low-risk, for which active surveillance (AS) is recommended rather than definitive local treatment. AS involves regular prostate-specific antigen (PSA) screenings and repeat biopsies every 12-18 months. Enrollment in AS significantly impacts mental health, as living with a cancer diagnosis can be burdensome. This study aims to assess whether pre-existing mental health diagnoses of anxiety and/or depression influence patients' compliance with AS.
Methods or Case Description: Patients with low-risk PCa were identified retrospectively from health records at multiple institutions between 2018 and 2022. They were categorized based on prior diagnoses of anxiety and depression. AS compliance was defined as having at least one PSA screening and one repeat biopsy within 18 months of diagnosis. Premature treatment was defined as receiving definitive therapy without disease progression. Data were analyzed using descriptive statistics and Fisher's exact test, with significance set at p< 0.05.
Outcomes: The average PSA at the time of diagnosis was 6.09 ± 2.75 ng/mL (n=379). Among patients with pre-existing diagnoses of anxiety and/or depression, 42% were compliant with AS. Non-compliance with AS was higher among patients with depression compared to those without (67% vs. 43%, p=0.042, odds ratio [OR]: 2.65, 95% confidence interval [CI]: 1.02 to 6.80). Patients with anxiety or depression had higher rates of premature treatment compared to those without such diagnoses (52% vs. 35%, p=0.028, OR: 2.02, 95% CI: 1.09 to 3.58).
Conclusion: Many men with low-risk PCa are prematurely treated or lost to follow-up. Those with pre-existing diagnoses of anxiety and/or depression have higher rates of non-compliance and overtreatment. The lack of proper AS compliance is likely due to a complex web of factors that should be further investigated.
Learning Objectives:
Define low-risk prostate cancer management and active surveillance.
Predict lost to follow up during active surveillance from patients with a history of anxiety or depression.
Recognize the importance of considering mental health management in low-risk prostate cancer management.
