Originally published as JCO Early Release 10.1200/JCO.2008.18.5850 on March 2 2009

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Patient Anxiety About Prostate Cancer Independently Predicts Early Initiation of Androgen Deprivation Therapy for Biochemical Cancer Recurrence in Older Men: A Prospective Cohort Study

From the Departments of Medicine, Sections of Geriatrics and Palliative Medicine and Hematology/Oncology, University of Chicago, Chicago, IL; Department of Neoplastic Diseases and Related Disorders, Medical College of Wisconsin, Milwaukee, WI; and Department of Medicine, James P. Wilmot Cancer Center, University of Rochester, Rochester, NY.

Corresponding author: William Dale, MD, PhD, Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, MC6098, 5841 S. Maryland Ave, Chicago, IL 60637; e-mail: wdale{at}medicine.bsd.uchicago.edu.

Purpose Androgen deprivation therapy (ADT) is first-line therapy for patients with prostate cancer (PCA) who experience 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.

Patients and Methods We conducted a prospective cohort study of older patients with BCR of PCA (n = 67). Patients completed questionnaires at presentation and each follow-up visit until initiation of ADT. PCA-specific anxiety was measured with the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). Other collected data included demographics, clinical information, and general anxiety information. 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 initiation 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 (odds ratio [OR], 9.19; P = .01). PSA also independently correlated with early initiation (OR, 1.31; P = .01). PSA did not correlate with MAX-PC.

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

Supported in part by Paul B. Beeson Career Development Award K23 (W.D.) and by the University of Chicago Cancer Research Center and Center for Health Administration Studies.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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