Purpose: Cancer anxiety is an important consideration in prostate cancer treatment decisions, but little information is available on fear of cancer recurrence and choice of primary treatment. In this study, we examined fear of recurrence, sociodemographic and clinical characteristics, and treatment choice among men diagnosed with localized prostate cancer.

Methods: Data were drawn from CaPSURE™, a national observational prostate cancer registry. Participants were 2,605 men diagnosed by biopsy with localized disease between 1989 and 2003. Fear of recurrence was measured at baseline following biopsy using 3 items that assess fear of cancer progression from Kornblith's original 5 item scale (alpha=0.82).

Results: Men who were single and those of nonwhite ethnicity, lower education, and lower income had greater fear of recurrence (ps<0.01). Also, those with higher risk for prostate cancer recurrence as determined by prostate specific antigen level, tumor characteristics, and stage, and those with more comorbid illnesses reported greater fear of recurrence (ps<0.01). Fear of recurrence was significantly associated with treatment choice with those receiving external beam radiation therapy, androgen deprivation therapy, and watchful waiting having higher anxiety than those receiving radical prostatectomy or brachytherapy (p<0.01).

Conclusions: Men of lower socioeconomic status were disproportionately affected by fear of cancer recurrence. While those at greater risk of prostate cancer recurrence reported greater fear of recurrence, men with greater anxiety received less definitive management (e.g., external beam radiation therapy) as compared to treatments that involve removal of the tumor (e.g., radical prostatectomy). Attending to fear of cancer recurrence at the time of selecting primary treatment for localized prostate cancer may be important in alleviating psychological distress and ensuring that choice of care matches psychosocial needs.