Prostate cancer survivors who were symptomatic at diagnosis have an increased risk of poor psychological wellbeing than men who were asymptomatic. Results from an all-Ireland survey

Background: Many asymptomatic men are diagnosed with prostate cancer (PCa) following prostate specific antigen (PSA) testing, others are symptomatic.  Rising incidence and survival means more men are living longer with PCa, however, information on long-term psychological wellbeing is lacking.  We explored factors associated with psychological well-being of PCa survivors, including symptoms at diagnosis.

Methods: A postal questionnaire was developed and administered in 2012 to 6,647 PCa (ICD10 C61) survivors 2-15 years post-diagnosis, identified through population-based cancer registries in the Republic of Ireland (RoI) and Northern Ireland (NI). "Asymptomatic" men were without symptoms, diagnosed via PSA testing, "symptomatic" men had urinary symptoms.  Psychological well-being was assessed using DASS-21.  Logistic regression was used to investigate predictors of depression, anxiety and stress (any severity). 

Results: Response was 52%.  Two-thirds of men were asymptomatic.  Depression, anxiety and stress were present in 16.6%, 16.5% and 10.6%, respectively.  In adjusted analysis, depression risk was increased in unmarried men (1.56 95%CI 1.19,2.05), those with co-morbidities (1.62 95%CI 1.29,2.03), current incontinence (1.73 95%CI 1.34,2.24), fatigue (2.46 95%CI 1.95,3.09) and those whose side-effects were worse than expected (2.22  95%CI 1.66,2.97).  Depression risk was higher in symptomatic compared to asymptomatic men (1.30 95%CI 1.04,1.61).  Similar associations were found for anxiety and stress. 

Conclusions: Groups of PCa survivors, including those with symptoms at diagnosis, are at increased risk of poor psychological health. This suggests that screening survivors for depression, anxiety and stress during follow-up maybe beneficial.  Development of interventions to support survivors' long term psychological wellbeing is required.