Waiting: Perhaps Less of a Stressor Than Expected

Craig Stoltz Health Guide
  • One of the most persuasive arguments against "watchful waiting"--taking no action on slow-growing prostate cancer contained to the gland until circumstances change--is that the anxiety of knowing there's a cancer down there is too much to bear. A surprising new study shows that, at least in one group of men observed, watchful waiters may not suffer high anxiety.


    Bottom line first


    According to a study on prostate cancer treatment appearing in the British journal BJU, men who choose to monitor early prostate cancer don't suffer any more anxiety or depression than men who get radiation and/or hormone treatment.

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    This study in 50 words or less


    British researchers gave over 300 men with prostate cancer psychological evaluations. The 100 men who were monitoring but not treating the disease had no greater incidence of depression or anxiety than those currently or previously treated with radiation.


    Yes, but. . .


    There are several potential confounders that make this study less than conclusive:


    Men weren't randomized to treatment groups. So the results may show only that men with less tendency to anxiety and depression are more likely to choose watchful waiting--not that any man who chooses watchful waiting is less likely to suffer depression or anxiety as a result.


    The watchful waiting group was compared only to men who received radiation treatment, not surgery.


    The men who were treated with radiation and/or hormones likely were dealing with the (often minimized by medical professionals pre-treatment) potentially debilitating side effects of urinary incontinence and impotence.


    The researchers found more depression and anxiety among younger men, and those who had been diagnosed for a longer time, without regard to which treatment option they chose.


    About 6 percent of men studied had depression, about 16 percent had anxiety. These numbers are only slightly higher than the general population.


    So what are you going to do about it?


    Most men diagnosed with early, slow-growing prostate cancer have the option of monitoring the condition until (or if) circumstances require action. This study suggests some men can choose this option without fear of increased anxiety or depression.


    After diagnosis, it's important to realize there is significant professional bias in treatment recommendations between radiologists (who treat cancer with radiation) and surgeons (who remove the prostate surgically). Neither professional group is motivated by self-interest to recommend watchful waiting.


    Studies into death rates comparing men who get treatment or not are maddeningly inconclusive, with evidence validating both treatment and non-treatment of low-grade tumors.


    Learn more


    Education is the best weapon for men entering the prostate cancer battle.


    Read this excellent overview of prostate cancer treatment options, including an exploration of the confounding data that makes decision making so difficult.


    The American Cancer Society has done a masterful job of navigating the professional, economical and emotional biases of the field with its research-based report on treatment options for prostate cancer.


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    The National Cancer Institue produces two reports that go into even more detail on prostate cancer and treatment options. Its "PDQ" report for prostate cancer patients is clear and dispassionate. If you want to go as deep as a layperson can, or deeper, read its PDQ on prostate cancer for medical professionals.


    We offer experts representing a range of viewpoints on prostate issues, including two urologists, a couple of veteran patients and a psychologist.


    Read this recent news story on a prostate cancer spouse study that concludes the disease is as emotionally costly--in some cases moreso--on wives as on patients themselves.



Published On: October 01, 2007