What to do About Active Surveillance Anxiety

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Men who choose active surveillance must live with uncertainty over whether a prostate tumor will turn aggressive. This uncertainty can exact an emotional toll: A 2019 study in the Journal of Urology found that 29 percent of men developed anxiety about their cancer in the year after diagnosis. Some end up abandoning active surveillance and seeking surgery or radiation when treatment may not be necessary.

A 2016 study in the Journal of Urology found that men in active surveillance regimens are more likely to develop anxiety if they are bothered by uncertainty. In addition, men had a nearly sevenfold increased risk for anxiety if they experienced urinary symptoms, such as a weak urine stream, probably because they interpreted the symptoms as evidence their cancer was worsening—though progressing cancer would not likely cause these symptoms. The authors note that if a man’s urinary symptoms are caused by an enlarged prostate, treating the root problem may bring both physical and psychological relief.

What else might help? Cognitive behavioral therapy, which involves changing “maladaptive” thinking, can help people become better able to accept uncertainty in life and has been shown to reduce anxiety. And a small, preliminary 2016 study in Psycho-Oncology found that practicing mindfulness meditation may help men who choose active surveillance to quiet uneasy thoughts.

Future research is likely to uncover effective anxiety management strategies for men on active surveillance. In the meantime, if you’re feeling anxious, don’t hesitate to talk to your doctor about your concerns.