PATIENT ANXIETY ABOUT PROSTATE CANCER INDEPENDENTLY PREDICTS EARLY INITIATION OF ANDROGEN DEPRIVATION THERAPY FOR BIOCHEMICAL CANCER RECURRENCE: A PROSPECTIVE COHORT STUDY

Purpose: Androgen deprivation therapy (ADT) is the standard of care for prostate cancer (PCa) patients with biochemical recurrence (BCR).  However, the optimal timing of ADT initiation is uncertain and earlier ADT initiation can cause toxicities that lower quality of life (QOL). We tested the hypothesis that elevated cancer anxiety leads to earlier ADT initiation for BCR in older men.

Methods: We conducted a prospective cohort study of older PCa patients with BCR (n = 67).  Patients completed questionnaires at presentation and each follow-up visit until initiating ADT.  PCa-specific anxiety was measured with the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). Other data collected included demographics, clinical information, and general anxiety.  Treating oncologists were surveyed about their recommendations for ADT initiation.  The primary outcome was the time to ADT initiation.  Univariate, multivariate logistic regression, and time-to-event analyses were conducted to evaluate whether cancer anxiety was a predictor of earlier receipt of ADT. 

Results:  Thirty-three percent of patients initiated ADT at the first or second clinic visit.  Elevated PCa anxiety (MAX-PC > 16) was the most robust predictor in multivariate analyses of early initiation (OR = 9.19; p = 0.01). PSA also independently correlates with early initiation (OR = 1.31; p = 0.01).  PSA did not correlate with MAX-PC.

Conclusion:  Cancer anxiety independently predicts earlier ADT initiation in older men with BCR.  For older PCa patients, earlier ADT initiation may not change life-expectancy and can impact QOL.  PCa-specific anxiety is a potential target for a decision-making intervention in this setting.  

Figure  1. Kaplan-Meier time-to-event curves by MAX-PC anxiety group by months until BCR patients receive ADT (p = 0.02).

Months	0	3	6	9	12	15	18	21	24	27	30	33	36	39
Elevated MAX-PC	15	7	6	4	4	4	3	2	0	0	0	0	0	0
Not Elevated	52	36	32	24	22	20	18	13	9	6	3	1	0	0