Prostate Cancer Diagnosis Calls for Early Support So That Men Can Make Smart Treatment Decisions, Study Says

Heather Orom, PhD, University of Buffalo
Heather Orom, PhD
June 8, 2015. BUFFALO, N.Y. — A study led by University of Buffalo and Roswell Park Cancer Institute researchers claims to have identified beliefs and personality traits associated with higher levels of distress in newly diagnosed prostate cancer patients. The study's authors say their findings support the value of emotional and informational support for patients and perhaps early counseling for some who are the most distressed.

“Several studies have examined distress in prostate cancer patients after treatment," said lead author Heather Orom PhD, an assistant professor of community health and health behavior in University of Buffalo's School of Public Health and Health Professions. "But few of these studies," Orom said, "assessed distress in men early in diagnosis, before receiving treatment."

Factors the study report identifies as associated with greater distress included a lack of confidence in deciding how to treat the cancer, being concerned that the cancer will progress, feeling that one’s masculinity is under threat and tendencies to be less optimistic and resilient.

This research was first published online in Psycho-Oncology in January 2015. Results from it and a second set of analyses are both based on a larger longitudinal study of prostate cancer patients, “Live Well Live Long!” The research involved assessments of 1,425 men newly diagnosed with prostate cancer at five different centers.

“To provide the correct support, we need a better understanding of what causes distress in these types of patients,” said Orom. "Our study provides a stronger empirical basis for designing or selecting interventions for these men.”

Willie Underwood III, MD, MPH, an associate professor in the Department of Urology at Roswell Park Cancer Institute, served as co-principal investigator on this study. Reflecting on his own field, Underwood said: “As urologists, we have to find better ways to assist men and their families after a prostate cancer diagnosis, which can be a difficult time for many. This study brings us one step closer to doing so.”

Dr. Underwood is certified by the American Board of Urology. His research interests include new treatments for prostate cancer and disparities influencing treatment of prostate cancer. Underwood is especially interested in prostate cancer treatment decision-making, prostate cancer survivorship and quality of life, and understanding the role of cancer risk perception in cancer screening.

Choosing more aggressive treatment

The second set of analyses from the “Live Well Live Long!” study revealed that emotional distress may motivate men diagnosed with prostate cancer to choose surgery.

“Importantly, greater distress was associated with choosing more aggressive treatment in men with lower-risk disease among those with potentially low-risk cancer,” said Orom. “These are men for whom active surveillance may be a viable option.

“Ideally, prostate cancer patients’ treatment decisions will reflect an accurate understanding of treatment options, assess treatment outcomes and chances of recovery, and also include personal preferences. Results of this study strongly support managing emotional distress in all prostate cancer patients.”

The second study, “Emotional Distress Predicts Choosing Surgery over Active Surveillance in Clinically Localized Prostate Cancer Patients,” assessed 1,050 men diagnosed with clinically localized prostate cancer; it was presented at the American Urological Association Annual Meeting on May 18. As yet, it has not been published.

Heading off long-term distress

Orom notes that previous studies have shown that for most men diagnosed with prostate cancer, anxiety, depression and emotional distress are highest at diagnosis and decline afterward. About a quarter to a third of men initially experience clinically significant emotional distress, including some who continue to experience psychological issues for many years after they are treated.

“Our findings suggest that providing early support when patients are deciding what treatment to pursue may help head off long-term distress,” Orom said, “and may also support men who are making a difficult decision among multiple treatment options with the potential for serious side effects.

“Understanding the factors associated with distress allows us to think in nuanced ways about the kinds of support needed by prostate cancer patients and when such support should be offered — particularly when men are first diagnosed.”

Orom noted that some men may benefit from further explanation of prostate cancer prognosis - i.e. more detailed forecast of the likely course of the disease and likely outcomes of the various treatments. Others may need more decision-making support. For some, she said, it may be important to discuss beliefs that prostate cancer and treatment side effects might threaten what is important to them as a man.

“Furthermore, developing interventions for men who are distressed at diagnosis could also improve clinical practice for all prostate cancer patients if it encourages more informative and supportive communication between providers and patients in general.”

Orom said that many men diagnosed with prostate cancer have a good prognosis. She notes that prostate cancer patients represent the second-largest group of cancer survivors in the U.S., with 2.8 million individuals.

Orom added there is a growing consensus that identifying and intervening to reduce emotional distress is an essential component of cancer care, and such actions are now recommended by the American Cancer Society, the National Comprehensive Cancer Network and others.

The study’s research group also included Carl A. Olsson, chief medical officer, and Deepak A. Kapoor, MD, chairman and CEO, Integrated Medical Professionals PLLC; Christian J. Nelson, assisting attending psychologist, Memorial Sloan Kettering Cancer Institute; Juan A. Reyna, MD, San Antonio Urology; and Zvi Schiffman, president, Houston Metro Urology. It is supported by a grant from the National Cancer Institute.

Sources & Links

Psychooncology. 2015 Jan 28. doi: 10.1002/pon.3751. [Abtract, Epub ahead of print]
Factors associated with emotional distress in newly diagnosed prostate cancer patients. Orom H, Nelson CJ, Underwood W 3rd, Homish DL, Kapoor DA.

Dr. Willie Underwood III's home page at Roswell Park Cancer Institute, Buffalo, NY, features a short video in which he expresses his feelings about his work as a cancer specialist. The quote on the photo at top of this page is from this video.

The US National Comprehensive Cancer Network has created a downloadable "distress thermometer" for patients to use and share with their doctors. NCCN defines patient distress as "an unpleasant emotional state that may affect how you feel, think, and act. It can include feelings of unease, sadness, worry, anger, helplessness, guilt, and so forth." "Everyone with cancer has some distress at some point of time," they state. "It is normal to feel sad, fearful, and helpless. Feeling distressed may be a minor problem or it may be more serious. You may be so distressed that you can’t do the things you used to do. Serious or not, it is important that your treatment team knows how you feel." Download directly from NCCN: