Elsevier

Urology

Volume 63, Issue 4, April 2004, Pages 751-756
Urology

Adult urology
Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer

https://doi.org/10.1016/j.urology.2003.11.017Get rights and content

Abstract

Objectives

To undertake a prospective longitudinal study to assess psychological and decision-related distress after the diagnosis of localized prostate cancer.

Methods

A total of 111 men (93% response rate) with localized prostate cancer were recruited from outpatient urology clinics and urologists' private practices. More than one half (56%) elected to undergo radical prostatectomy, 19% underwent external beam radiotherapy, and 25% chose watchful waiting. Men completed self-report measures before treatment and 2 and 12 months after treatment. The measures used included the University of California, Los Angeles, Prostate Cancer Index, International Prostate Symptom Score, Impact of Events Scale, Constructed Meaning Scale, Satisfaction with Life Scale, Health Care Orientation subscale, and Decisional Conflict Scale.

Results

No statistically significant differences were found by medical treatment group in the psychological and decision-related adjustment at baseline or with time. Men who were undecided about their treatment choice had greater decisional conflict and a more negative healthcare orientation, but were not more psychologically distressed, compared with men who had decided. At diagnosis, 63% of men had high decision-related distress, and this persisted for 42% of men 12 months after treatment, despite high satisfaction with their treatment choice. At diagnosis, low-to-moderate psychological distress was most common, with distress decreasing after treatment. The overall quality of life was similar to community norms.

Conclusions

The results of our study indicated that men who were undecided about what treatment to receive experienced greater decision-related distress. The final treatment choice was not related to psychological distress about prostate cancer. Psychological and decision-related distress decreased with time, independent of treatment modality. Interventions should target decision-related distress for all men and in-depth psychological support for those who experience ongoing difficulties.

Section snippets

Material and methods

The participants were men newly diagnosed with localized prostate cancer recruited during a 20-month period from 1999 to 2001 from two hospital urology clinics and four urologists' private practices in Queensland, Australia for a study into men's decision making about cancer treatment.9 The inclusion criteria were newly diagnosed localized prostate cancer, considering treatment with curative intent; ability to read and speak English; no previous history of head injury or dementia; no concurrent

Results

The sociodemographic characteristics of the participants are described in Table I. At baseline, younger age was associated with greater levels of intrusion (r = 0.27, P <0.01), fewer sexual symptoms (r = 0.45, P <0.001), and lower sexual bother (r = 0.32, P <0.001). Men who underwent radical prostatectomy were younger (mean age 58.3 ± 7.9 years) than men who underwent external beam radiotherapy (mean age 64.5 ± 5.3 years; P = 0.002) or watchful waiting (mean age 66.6 ± 7.2 years; P <0.0005).

Comment

In contrast to previous research, we found no differences in men's psychological adjustment and global quality of life on the basis of medical treatment group, either at baseline or with time.20 The levels of psychological distress in these men were greatest close to diagnosis, decreasing significantly 2 months after treatment. Parallel to this, the patterns of adjustment for domain-specific physical effects were similar to previous studies. The symptoms were worse 2 months after treatment,

Conclusions

The treatment received did not affect the psychological or decision-related adjustment at baseline or with time, and psychological distress was not found to be associated with the treatment choice. Men's global quality of life was consistent with community norms for noncancer populations. Psychological distress was greatest close to diagnosis; however, 12 months after treatment, most men reported low distress. With time, a subgroup of men remained highly distressed, suggesting the need to trial

Acknowledgements

To the Queensland Cancer Fund and the Royal Brisbane Hospital and Redcliffe Hospital for their assistance in the undertaking of this study.

References (24)

  • M.A. Perez et al.

    Sexuality and intimacy following radical prostatectomypatient and partner perspectives

    Health Psychol

    (2002)
  • J.I. Bisson et al.

    The prevalence and predictors of psychological distress in patients with early localized prostate cancer

    Br J Urol Int

    (2002)
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