Patient-Reported Psychological and Prostate Cancer-Specific Functional Outcomes Among Men With Low-Risk Prostate Cancer Two Years After Diagnosis: The PREPARE Prospective Cohort Study - 21/04/26

Doi : 10.1016/j.urology.2026.03.002

Kimberly M. Davis ^a,^⁎ , George Luta ^b, Richard M. Hoffman ^c, Tania Lobo ^a, Vasiliki Zotou ^a, Arnold L. Potosky ^a, Martin G. Sanda ^d, David Penson ^e, Farzin Khosrow-Khavar ^f,^g,^h, Isaac J. Ergas ⁱ, Stephen K. Van Den Eeden ⁱ, Kathryn L. Taylor ^a

^a Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC

^b Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC

^c Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA Cancer Epidemiology and Population Science Program, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA

^d Department of Urology, Emory University, Atlanta, GA

^e Department of Urology, Vanderbilt University Medical Center and the VA Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN (DP)

^f Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ

^g Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Rutgers, The State University of New Jersey, New Brunswick, NJ

^h Cancer Prevention and Control Research Program, Rutgers Cancer Institute, New Brunswick, NJ

ⁱ Division of Research, Kaiser Permanente Northern California, Pleasanton, CA

^⁎ Address correspondence to: Kimberly M. Davis, Ph.D., Departments of Oncology and Psychiatry, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Ave., NW, Suite 300, Washington, DC 20007. Departments of Oncology and Psychiatry, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center 2115 Wisconsin Ave., NW, Suite 300 Washington DC 20007

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ABSTRACT

Objective

To compare general anxiety and prostate cancer (PCa)-specific anxiety and PCa-specific functioning reported at 24 months after diagnosis between men who initially chose and remained on active surveillance (AS), those who initially chose active treatment (AT), and those who initially chose AS but later switched to AT (Delayed AT).

Methods

We conducted telephone interviews (N = 1139) after initial diagnosis (but before treatment) and follow-up interviews 2 years thereafter (N = 950; 87.1%). We assessed anxiety (general and PCa-specific) and PCa-specific function, comparing AS (N = 442), AT (N = 420), and Delayed AT (N = 88) at 24 months using multivariable linear regression.

Results

Adjusting for pre-treatment anxiety, clinical, and sociodemographic factors, the AS group reported higher general anxiety (mean = 48.4) than the AT group (mean = 46.5, P = .01) but did not differ from the Delayed AT group (mean = 48.7, P = .76). The AS group also reported higher PCa-specific anxiety (mean = 10.9) compared to both treatment groups (9.2, P < .0001). However, the AS group reported significantly better PCa-related outcomes than either treatment group for urinary incontinence, sexual function, and bowel function (all P -values < .01).

Conclusion

At 2 years after diagnosis, men who remained on AS reported significantly higher general anxiety than the AT group, and significantly higher PCa-specific anxiety compared to the AT or Delayed AT groups. Our findings highlight the importance of assessing general and prostate-specific anxiety alongside physical functioning to help tailor disease management for men with low-risk PCa.

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