Reviewed research

Authors R van den Bergh, M-L Essink-Bot, M Roobol, F Schroder, C Bangma, E Steyerberg

Review Date Apr 2010

Citation J Urology 2010;183:1786-1791



Active surveillance (AS), sometimes called ‘watchful waiting’, is an option for men after a diagnosis of localised prostate cancer. The advantage of this approach is that side-effects of treatments are avoided in men for whom the cancer is not going to progress. However, a minority of men choose this option and it is thought that anxiety about living with a diagnosis of cancer may partly explain the low uptake.

Little is known about how men undergoing AS fare psychologically but this information could be helpful when men with localised prostate cancer are making decisions about treatment with their doctors.



To monitor anxiety and distress in men undergoing AS over a period of 9 months from diagnosis of localised prostate cancer.



150 Dutch patients with prostate cancer on active surveillance in a prospective active surveillance study received questionnaires at study inclusion and 9 months after diagnosis. The authors assessed changes in scores on the decisional conflict scale, the Center for Epidemiologic Studies Depression Scale, the State Trait Anxiety Inventory, the Memorial Anxiety Scale for Prostate Cancer and the self-estimated risk of progression. Scores 9 months after diagnosis vs those at study inclusion for physical health (SF-12(R) physical component summary), personality (Eysenck Personality Questionnaire), shared decision making, prostate cancer knowledge, demographics, medical parameters and prostate specific antigen doubling time during follow-up were explored.



Questionnaires at study inclusion and 9 months after diagnosis were completed by 129 of 150 (86%) and 108 of 120 participants (90%) a median of 2.4 and 9.2 months after diagnosis, respectively. Anxiety and distress at study inclusion were previously found to be generally favourable. Significant but clinically irrelevant decreases were seen in mean scores of the State Trait Anxiety Inventory (p = 0.016), Memorial Anxiety Scale for Prostate Cancer fear of progression subscale (p = 0.005) and the self-estimated risk of progression (p = 0.049). Anxiety and distress 9 months after diagnosis were mainly predicted by scores at study inclusion.

Higher Eysenck Personality Questionnaire neuroticism score and an important role of the physician in the treatment decision had additionally unfavourable effects. Good physical health, palpable disease and older age had favourable effects. No association was seen for prostate specific antigen doubling time. Nine men discontinued active surveillance, including 2 due to nonmedical reasons.



Anxiety and distress generally remained favourably low during the first 9 months of surveillance.

Limitations: The men in this study had already made a decision to choose AS and thus may have had better psychological wellbeing at baseline compared to others who chose active treatment. A study randomising men to different treatment options would be a better study design. A follow-up time of 9 months is relatively short and it would be interesting to know longer term psychological outcomes. 


Points to Note
  1. A group of men on active surveillance after a diagnosis of localised prostate cancer showed low levels of anxiety and distress at the time of diagnosis and 9 months later.
  2. The main predictor of each psychological outcome variable at 9 months was the baseline level.
  3. A neurotic personality type and a perceived important role of the physician in the decision were associated with worse psychological outcomes.
  4. The few studies that have been done suggest that AS does not lead to increased psychological distress but further well designed studies are needed to fully understand the experience of men undergoing AS.
  5. An Australian study comparing psychological outcomes over 12 months in men undergoing different treatments for localised prostate cancer, including AS, also showed the AS group to fare well psychologically, particularly compared to those undergoing androgen deprivation therapy. (Couper JW et al. MJA 2009;190:S86-S89)


Website: http://www.ncbi.nlm.nih.gov/pubmed/20299064

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