Anxiety and depression associated with a positive prostate biopsy result: A comparative, prospective cohort study

Sefik, Ertugrul; Gunlusoy, Bulent; Eker, Anil; Celik, Serdar; Ceylan, Yasin; Koskderelioglu, Asli; Basmaci, Ismail; Degirmenci, Tansu

doi:10.1590/S1677-5538.IBJU.2019.0719

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ORIGINAL ARTICLE • Int. braz j urol 46 (6) • Nov-Dec 2020 • https://doi.org/10.1590/S1677-5538.IBJU.2019.0719 copy

Anxiety and depression associated with a positive prostate biopsy result: A comparative, prospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To investigate the course of anxiety and depression before and after transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and in the postoperative 1st month when the histopathological biopsy result was obtained.

Methods

In between June 2017- January 2019, 204 patients who underwent TRUS-Bx and completed the questionnaires assessing anxiety and depression were included in the study. Questionnaires were completed immediately before the biopsy, immediately after the biopsy and at the end of the first month when the histopathological biopsy results were given. State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS) and perceived stress scale (PSS) forms were used to assess anxiety and depression. After the histopathological examination patients were divided into two groups as patients without cancer (Group 1) and with cancer (Group 2). Data was compared between the groups.

Results

PSA level was negatively correlated with STAI TX-1 scores of the patients immediately after TRUS-Bx, whereas it was positively correlated with STAI TX-1 and TX-2 30 days after the TRUS-Bx. PSA level was positively correlated with HADS-A and HADS-D scores immediately before and 30 days after TRUS-Bx. Biopsy results showed a significant difference in 30 day post-biopsy related data. STAI TX-1, STAI TX-2, HADS-A, HADS-D and PSS scores were higher in Group 2 compared with Group 1.

Conclusions

Pre-biopsy anxiety disappeared after bx, but there was a significant increase in anxiety and depression in patients after the diagnosis of malignancy. Patients were seriously concerned about the diagnosis of prostate cancer.

Prostate-Specific Antigen; Biopsy; Anxiety; Depression

Variable		n=204
Age (years), mean ± SD (min-max)		64.8±6.7 (48-78)
PSA (ng/mL), mean ± SD (min-maks)		10.7±14.9 (0.9-128.8)
Prostate volume (cc), mean ± SD (min-max)		55.9±25.6 (20-135)
	Normal	132 (64.7)
DRE , n (%)	Abnormal	72 (35.3)
Education , n (%)	illiterate	16 (7.8)
	Primary school	128 (62.7)
	High school	48 (23.5)
	Graduate	12 (5.9)
Before TRUS-BX, STAI, mean ± SD (min-max)	TX-1	38.7±10.4 (20-64)
Before TRUS-BX, STAI, mean ± SD (min-max)	TX-2	42.2±8 (21-64)
Before TRUS-BX, HADS, mean ± SD (min-max)	HADS-A	5.5±3.2 (0-14)
Before TRUS-BX, HADS, mean ± SD (min-max)	HADS-D	5.7±3.4 (0-16)
Before TRUS-BX, PSS-14, mean ± SD (min-max)		22.1±6.3 (2-33)
After TRUS-BX, STAI, mean ± SD (min-max)	TX-1	38.1±9.8 (20-57)
After TRUS-BX, STAI, mean ± SD (min-max)	TX-2	40.1±6.7 (24-56)
After TRUS-BX, HADS, mean ± SD (min-max)	HADS-A	5.2±3.4 (0-14)
After TRUS-BX, HADS, mean ± SD (min-max)	HADS-D	5.6±3.5 (0-15)
After TRUS-BX, PSS-14, mean ± SD (min-max)		20.7-6.4 (0-34)
Postoperative 1 st month STAI, mean ± SD (min-max)	TX-1	31.5±12.1 (20-59)
Postoperative 1 st month STAI, mean ± SD (min-max)	TX-2	32.8±12.3 (20-60)
Postoperative 1 st month HADS, mean ± SD (min-max)	HADS-A	3.6±3.4 (0-16)
Postoperative 1 st month HADS, mean ± SD (min-max)	HADS-D	3.2±3.2 (0-13)
Postoperative 1st month PSS-14, mean ± SD (min-max)		17.7±7.9 (5-34)

		Age	PSA	VAS score
Before TRUS-BX, STAI	TX-1	R=-0.016, p=0.877	R=0.1, p=0.316	R=0.105, p=0.292
Before TRUS-BX, STAI	TX-2	R=-0.047, p=0.640	R=0.156, p=0.117	R=-0.037, p=0.712
Before TRUS-BX, HADS	HADS-A	R=-0.065, p=0.518	R=0.211, p=0.033	R=0.103, p=0.304
Before TRUS-BX, HADS	HADS-D	R=0.041, p=0.682	R=0.255, p=0.010	R=-0.066, p=0.511
Before TRUS-BX PSS-14		R=-0.032, p=0.749	R=0.131, p=0.19	R=0.112, p=0.263
After TRUS-BX STAI	TX-1	R=-0.224, p=0.024	R=-0.224, p=0.024	R=0.117, p=0.241
After TRUS-BX STAI	TX-2	R=-0.132, p=0.184	R=-0.132, p=0.184	R=0.162, p=0.104
After TRUS-BX, HADS	HADS-A	R=-0.181, p=0.068	R=-0.181, p=0.068	R=0.280, p=0.004
After TRUS-BX, HADS	HADS-D	R=-0.121, p=0.225	R=-0.121, p=0.225	R=0.159, p=0.111
After TRUS-BX PSS-14		R=-0.116, p=0.249	R=-0.116, p=0.249	R=0.120, p=0.231
Postoperative 1^st month STAI	TX-1	R=0.042, p=0.674	R=0.256, p=0.009	R=0.117, p=0.243
Postoperative 1^st month STAI	TX-2	R=0.067, p=0.503	R=0.260, p=0.008	R=0.060, p=0.547
Postoperative 1 ^st month HADS	HADS-A	R=-0.115, p=0.250	R=0.294, p=0.003	R=0.189, p=0.057
Postoperative 1 ^st month HADS	HADS-D	R=0.022, p=0.225	R=0.402, P<0.001	R=0.074, p=0.457
Postoperative 1 ^st month PSS-14		R=0.054, p=0.593	R=0.286, p=0.004	R=0.235, p=0.017

Variables : median (min-max)		Group 1 (Benign) (n=142)	Group 2 (prostate cancer ) (n=62)	p
Age (years)		64 (48-78)	69 (48-78)	0.135
PSA (ng/mL)		6 (0.9-37)	8 (3.6-128,8)	0.006
Prostat volume (cc)		55 (25-120)	40 (24.3-135)	<0.001
DRE, n (%)	Normal	102 (71.8)	30 (48.4)	0.005
DRE, n (%)	Abnormal	40 (28.2)	32 (51.6)	0.005
STAI TX-1	Before TRUS-BX	39 (20-64)	41 (23-58)	0.346
	Postoperative 1 ^st month	22 (20-59)	46 (20-58)	<0.001
	∆ STAI TX-1	-10 (-35 - +19)	6 (-21 - +21)	<0.001
STAI TX-2	Before TRUS-BX	42 (21-64)	43 (31-60)	0.469
	Postoperative 1 ^st month	24 (20-59)	49 (34-60)	<0.001
	∆ STAI TX-2	-15 (-35 - +5)	4 (-17 - +21)	<0.001
HADS-A	Before TRUS-BX	6 (0-14)	6 (1-13)	0.406
	Postoperative 1 ^st month	2 (0-16)	7 (1-13)	<0.001
	∆ HADS-A	-2 (-9 - +7)	1 (-7 - +6)	<0.001
HADS-D	Before TRUS-BX	5 (0-16)	7 (0-13)	0.322
	Postoperative 1 ^st month	2 (0-9)	7 (1-13)	<0.001
	∆ HADS-D	-3 (-12 - +2)	0 (-5 - +4)	<0.001
PSS-14	Before TRUS-BX	22 (2-33)	23 (10-33)	0.281
	Postoperative 1 ^st month	12 (5-27)	29 (15-34)	<0.001
	∆ PSS-14	-9 (-18 - +8)	4 (-8 - +13)	<0.001

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[1] Correspondence address: Ertugrul Sefik Department of Urology Health Sciences University, Bozyaka Training and Research Hospital, Saim Cikrikci cad. No: 37, Bozyaka, Izmir, Turkey Fax: +90 232 261-4444 E-mail: sefikanamur@yahoo.com