Open Access

ARTICLE

Mind matters: how anxiety and depression shape low-risk prostate cancer active surveillance adherence in a real-world population

Zachariah Taylor^1,*, Kayla Meyer², Danielle Terrenzio², Ryan Wong³, Sharon Larson⁴, Stephanie Kjelstrom⁴, Natalina Contoreggi⁵, Laurence Belkoff^1,6, Ilia Zeltser^1,6

1 Main Line Health System, Wynnewood, PA 19096, USA
2 Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA
3 Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL 33328, USA
4 Lankenau Institute of Medical Research, Penn Wynne, PA 19096, USA
5 Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
6 MidLantic Urology, Bryn Mawr, PA 19010, USA

* Corresponding Author: Zachariah Taylor. Email:

Canadian Journal of Urology 2025, 32(1), 21-27. https://doi.org/10.32604/cju.2025.064705

Received 11 December 2024; Accepted 20 January 2025; Issue published 20 March 2025

Abstract

Purpose: While the mental health impact of a prostate cancer diagnosis, including low-risk prostate cancer, is well-documented, the effect of pre-existing anxiety and/or depression on adherence to active surveillance protocols in low-risk prostate cancer patients remains unclear. This study assessed the association between prior anxiety and/or depression and active surveillance adherence in men with low-risk prostate cancer. Methods: We conducted a retrospective, multicenter study involving 426 men diagnosed with low-risk prostate cancer who were recommended active surveillance as the primary management strategy. Active surveillance adherence was defined by completion of both a prostate-specific antigen test and a prostate biopsy within 18 months of diagnosis. Premature treatment was identified as definitive treatment, either through radiation therapy or radical prostatectomy. Results: Men with a prior mental health diagnosis were significantly less likely to adhere to active surveillance than those without such a diagnosis (27.6% vs. 49.5%, p = 0.006). These individuals had lower adherence rates for prostate-specific testing (58.6% vs. 73.4%) and biopsy (27.6% vs. 50.0%) and were more likely to abandon active surveillance in favor of immediate treatment (39.7% vs. 25.0%, p = 0.005). No significant differences were observed between patients with both anxiety and depression versus those with a single diagnosis. Conclusions: Pre-existing anxiety and/or depression is associated with reduced active surveillance adherence and a greater likelihood of premature treatment in men with low-risk prostate cancer. These findings highlight the importance of addressing psychiatric factors in low-risk prostate cancer management and suggest avenues for future research.

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