Anxiety Linked to Prostate Biopsies

[[{"type":"media","view_mode":"media_crop","fid":"21129","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_348222958756","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1405","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]The US Preventive Services Task Force (USPSTF) recommends against screening for prostate cancer by prostate-specific antigen (PSA) testing, stating that the benefits of screening do not outweigh the complications caused by unnecessary biopsies and treatments. Studies have produced conflicting results on the benefits of PSA screening. Still, up to a million biopsies are performed annually among Medicare beneficiaries following a PSA test.

How clinically useful PSA screening is for men who have no symptoms remains a question that polarizes clinicians.

In a recently published prospective study, researchers examined the psychological impact of prostate cancer biopsies. The results show that men who have post-biopsy symptoms have increased anxiety, even if they have received a negative diagnosis. This anxiety is symptom-related rather than diagnosis-related, concluded the authors.

The authors suggest that these anxieties need to be considered before a patient undergoes PSA screening. The results are published in the Journal of Clinical Oncology.

“We found that most men described prostate biopsies as ‘uncomfortable’, but around 40% reported pain and many experienced bleeding, which sometimes lasted for 5 weeks or longer,” said lead author Julia Wade, PhD, of the University of Bristol School of Social and Community Medicine in Bristol, United Kingdom. While most men thought these were minor issues, about 11% of those with pain, 22% of those with fever, and 26% of those with hemoejaculate considered these problematic issues.

Wade and colleagues analyzed a prospective cohort of over 1,000 men, as part of the Prostate Biopsy Effects study, who were advised to undergo a prostate biopsy. All participants were part of the larger Prostate Testing for Cancer and Treatment study of more than 100,000 men across the United Kingdom. The men completed questionnaires on their physical and psychological harms after the biopsy. Psychological impact of the biopsy 7 and 35 days after the procedure was assessed by the Hospital Anxiety and Depression Scale.

The study showed that the majority of men had minor biopsy-related symptoms and a low level of anxiety and depression similar to that of the general population. Of the 471 men who had a negative biopsy result, anxiety was highest in those men who had moderate to major symptoms such as pain, shivers, hematuria, hematochezia, and hemoejaculate at day 7. At day 35, anxiety was lessened, as the men were reassured, but still experienced symptoms.

Adverse effects from biopsies can include bleeding, pain, as well as sexual and urinary symptoms. Febrile infection is the most common reason for hospitalization within 30 days post-biopsy. About 1% to 7% of men are hospitalized.

In the Prostate Biopsy Effects study, 1.3% of the men had to be hospitalized. Symptoms post-biopsy included pain (43.6%), fever (17.5%), hemoejaculate (92.6%), hematuria (65.8%), and hematochezia (36.8%). These symptoms were moderate or major for a minority of patients.

“Post-biopsy symptoms such as pain/discomfort and bleeding were experienced relatively commonly, although for the majority of men, the symptoms were tolerated as a minor problem or as no problem,” said the authors.

The researchers suggest that better information in preparation for a biopsy, including what to expect, could reduce unnecessary anxiety as well as potentially unnecessary health care contact when a patient experiences symptoms following the procedure.

“We hope that our study provides men with more information about diagnosing prostate cancer. We think that men should have as much information as possible about the possible consequences of having a PSA test before they decide to take the test,” Wade told Cancer Network. “It is important that they know that if their PSA levels is raised, they will be advised to have a prostate biopsy.”

Next, the researchers plan to investigate whether improved information about biopsies and their effects may reduce anxiety and impact the number of men who opt to undergo PSA testing.