Purpose: To test the influence that prostate cancer patients' anxiety has on the decision to start androgen deprivation therapy (ADT) when prostate specific antigen (PSA) rises following initial therapy for localized prostate cancer. Standard care for men with prostate cancer recurrence after localized treatment is ADT. However, when to start ADT remains controversial. Early initiation of ADT is not cost-effective or conclusively proven to raise life expectancy, and ADT is associated with significant quality of life affecting side effects. We hypothesize that men with higher prostate cancer-specific anxiety levels will initiate ADT earlier than others, independent of PSA levels. We tested this hypothesis with a sample of patients with rising PSA.

Method: Patients with rising PSA are surveyed at their initial and subsequent visits to genitor-urinary oncology clinics at The University of Chicago until they start ADT (n = 34). The surveys ask about socio-demographics, quality of life, the Hospital Anxiety and Depression Scale (HADS), and the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). PSA levels and other relevant clinical variables are extracted from the medical record. T-tests are performed comparing anxiety levels, PSA levels at ADT initiation, and Gleason scores at diagnosis in those starting on ADT within the first 3 months versus those not starting.

Results: Patients showed varying degrees of general anxiety (HADS-A, mean = 5.68 ± 4.12), but they had significant levels of prostate cancer-specific anxiety (MAX-PC, mean = 21.97 ± 8.87). To date, 8 patients have started ADT therapy within 3 months of the initial visit, and they show a significantly higher prostate cancer related anxiety than those who had not started ADT (26.9 vs.19.2; p = .02). PSA levels are insignificantly higher in the men starting on therapy (4.86 vs. 9.59; p = 0.26), and Gleason scores at diagnosis are similar (6.12 vs. 6.33; p = 0.72).

Conclusion: These preliminary findings support the hypothesis that patients with higher prostate cancer-specific anxiety begin ADT earlier, while PSA and Gleason scores are not significantly higher in those starting earlier. While the clinical value of early initiation of ADT for asymptomatic patients with rising PSA is controversial, these results suggest that prostate cancer-specific anxiety is a trigger for the initiation of ADT, and should be considered in counseling patients about such therapy.