Introduction.

Living with untreated prostate cancer (PCa) may cause distress in men on Active Surveillance
(AS). We aimed to evaluate PCa-related anxiety from enrolment to one year after the first re-biopsy.
Patients and Methods.
Between 2007-2014, 207 patients progressively completed the Memorial Anxiety Scale for Prostate
Cancer (MAX-PC), a self-report tool providing 4 indexes: PCa anxiety , PSA anxiety, fear of
recurrence, MAX-PC total score. Assessment was conducted at entrance in AS protocol (T0), 2
months before first re-biopsy from diagnostic one (T1), after re-biopsy (T2) and 1 year after rebiopsy (T3). On average, patients completed MAX-PC at T3 after 19 months from entrance.
Cronbachs coefficients were calculated to estimate reliability. Descriptive analyses were
performed. Wilcoxon test was used to detect statistically significant changes over time. Changes
with effect size (ES) 0.5 or -0.5 were considered as clinically relevant (1).
Results.
Two hundred and seven patients completed the MAX-PC at T0. Mean age of sample at diagnosis
was 64 years (SD=7; 42-79 yrs). Figure 1 shows results of descriptive analyses. The majority of
patients had low scores in all the subscales and the MAX-PC total index (coefficients of
skewness>0). Cronbach values ranged from 0.76-0.93 and were similar to the reliability indexes
of the original scale (2).
Wilcoxon test showed statistically significant reductions in MAX-PC total score (N=52, 61% of pts,
p=0,0006) and PCa anxiety subscale (N=49, 58% of pts, p=0,0012) between T1 and T2. These
variations were found to be clinically meaningful (ES0,5) for 19% (N=16) and 22% (N=19) of
patients, respectively. Statistically significant increases were found between T1 and T2 in MAX-PC
total (N=24, 28% of pts, p=0,0006) and PCa anxiety (N=25, 29% of pts, p=0,0006) scores. These
changes emerged as clinically meaningful (ES-0.5) for 7% (N=6) and 9% (N=8) of patients,
respectively.
Conclusions.
Our results showed PCa anxiety as favourably low over time for most of the men in our sample. A
decrease in anxiety occurred after the first re-biopsy which may highlight a potentially reassuring
role of the medical examinations included in the AS monitoring scheme. Despite a small group of
patients experienced an increase of PCa anxiety, scores mostly remained at the low or mid-range
level. Our findings about PCa anxiety in AS are coherent with other studies (3).
We found that the Italian version of the MAX-PC that we developed had good reliability. Further
research is needed to confirm the validity in the Italian population of AS patients. In conclusion, we
may argue that overall PCa anxiety did not represent a major burden for our AS patients.
Acknowledgements to Foundation I. Monzino.
1. Norman et al. (2003) Medical Care.
2. Roth et al. (2006). Psychosomatics.
3.Venderbos et al. (2014). Psycho-Oncology.