PSA testing anxiety, psychological morbidity, and PSA utility in the management of prostate cancer.

Anecdotal reports from urologists and medical oncologists have suggested that patients with prostate cancer (PCa) often present with anxiety related to ongoing monitoring of their PSA levels as part of their disease management. The purpose of the current study, therefore, was to determine the prevalence and severity of prostate specific antigen (PSA) testing anxiety in a population of patients with either localised or metastatic PCa living in Australia. Other aspects of psychological morbidity associated with monitoring PSA levels and the impact of PSA utility (i.e., attitudes and beliefs towards PSA testing from the patient's perspective) on PSA testing anxiety was also investigated. The sample comprised 70 participants, 47 with localised PCa (M age == 68.43 years, SD == 8.54) and 23 with metastatic PCa (M age == 74.35 years, SD == 7.41). Participants with either localised or metastatic PCa were recruited during an 11 month period from May 2009 to March 2010 through either their treating urologist or medical oncologist at Cabrini Health Melbourne, Australia, or through Cancer Voices Victoria or the Prostate Cancer Foundation Australia. Participants were required to complete a questionnaire booklet that comprised sociodemographic and medical questions, the Hospital Anxiety and Depression Scale; the State¬Trait Anxiety Inventory-Trait Scale~ the Memorial Anxiety Scale for Prostate Cancer; the Functional Assessm~nt of Cancer Therapy Scale¬Prostate, and the PSA Utility (PSAU) Scale, a measure developed specifically for the current study. Level of PSA testing anxiety was low with 75% of participants with localised and 78% of participants with metastatic disease reporting no PSA testing anxiety. Four per cent of participants with localised PCa reported borderline elevated PSA testing anxiety. Significant differences in PSA testing anxiety were not found by disease status or for changes in PSA level. Low state anxiety and depression and high QoL were generally observed in the sample. Participants with metastatic disease reported significantly higher levels of depression than participants with localised disease. PSA testing anxiety was moderately related to state and trait anxiety, depression and emotional QoL. Trait anxiety was related to all of the subscales of the MAX-PC. PSA utility was high for the majority of the sample and was not associated with PSA testing anxiety, but was related to PCa anxiety and depression. The relationship between PSA testing anxiety and trait anxiety suggests that measuring trait anxiety could be a method for identifying patients inclined to experience anxiety associated with the monitoring of their PSA levels. Further, the study specific PSAU Scale provided evidence of the high level of importance participants place on the PSA test, regardless of the stage of their disease. With further psychometric testing, the PSAU Scale could become a useful tool in identifying the attitudes and beliefs about PSA testing that may perpetuate anxiety in patients with PCa, and in detecting patients who would benefit from further education about PSA testing. The results of the current study highlighted the necessity for the development of more sensitive and comprehensive measures of PSA testing anxiety to address the discrepancy between anecdotal reports by treating specialists and patient self-report of the prevalence and severity of PSA testing anxiety. The limitations of the study, implications of the results for theory and practice, and directions for future research were discussed.