Prostate cancer diagnosis and surgery can lead to anxiety, depression and reduced quality of life

"The 10-year survival for a man undergoing surgery to remove localized prostate cancer is greater than 95 percent. Given that the majority of men who undergo prostatectomy for prostate cancer will not die from their disease, we are concerned about what life will be like for these patients decades after diagnosis and treatment," says the study's senior investigator, Alexander Parker, Ph.D., an associate professor of epidemiology and urology.

While prostate cancer can be a life threatening disease, most men diagnosed with prostate cancer do not die from it. According to the American Cancer Society, more than 2.5 million men in the United States who have been diagnosed with prostate cancer are still alive.

"The odds of surviving for long periods of time following surgery for prostate cancer are very high," says surgeon and co-author Gregory Broderick, M.D., a professor of urology. "That means a lot of men are living as prostate cancer survivors and we at Mayo Clinic are committed to understanding factors that affect their quality of life, not just their quantity of life."

Dr. Broderick presented these results at the joint meeting of the Sexual Medicine Society of North America and the International Society for Sexual Medicine this summer in Chicago.

Data from studies in patients with other cancer types have shown that anxiety can significantly affect an individual's quality of life. "Our study is the first to specifically show that those men with higher cancer-specific anxiety one year after surgery for prostate cancer are more likely to report lower levels of satisfaction with their sex life and higher levels of depressive symptoms," Dr. Parker says. In their study, the Mayo Clinic researchers examined findings on 365 men who, one year after undergoing surgery for prostate cancer, completed a questionnaire designed to measure anxiety levels about the fact they have been diagnosed and treated for prostate cancer. The men also completed additional questionnaires to measure levels of erectile function, sexual satisfaction and depression.

The results showed that those men who reported high anxiety levels are more likely to report low sexual satisfaction and a high rate of depression symptoms. "What is interesting from the sexual health standpoint is we observed that anxiety was not linked to poor erectile function per se but was linked to low levels of sexual satisfaction," Dr. Parker says. "If our results can be confirmed by other investigators, it would suggest that anxiety is not affecting some men's ability to perform sexually but perhaps more their ability to enjoy their sex life."

While Dr. Parker and his colleagues observed that anxiety was generally higher in those men who had the more aggressive forms of prostate cancer based on their pathology reports after surgery, a number of men with nonaggressive cancer also reported very high levels of anxiety. "Among this specific subgroup of men with prostate cancer who have less aggressive disease we are talking about survival rates of nearly 100 percent, yet they think about cancer every day. This presents a great opportunity for identifying these men and offering intervention aimed at modifying this anxious behavior," Dr. Parker says.

Mayo Clinic already offers cancer patients access to behavior-based counseling led by trained psycho-oncologists. Dr. Parker says the results of this new study underscore the opportunity to test new ways of addressing this need in men with prostate cancer.

"Anxiety about a cancer diagnosis can lead to increased depressive symptoms and an inability to enjoy life's activities, including sexual relations," says Dr. Parker. "We are building on these results by designing trials to test whether counseling can help these patients."

The study was funded in part by a grant from the Sexual Medicine Society of North America.