When Active Surveillance for Prostate Cancer Causes Anxiety: 7 Tips to Help You Cope

Although this active monitoring is a safe and sometimes preferable way to manage certain prostate cancers, not treating the cancer right away can cause anxiety. For some men, waiting is the hardest part.

"The thought that you have cancer and you're not doing anything about it — you're basically living with cancer — is unsettling for many people," says Mohit Khera, MD, MPH, a professor of urology at Baylor College of Medicine in Houston. "Every time they get a PSA test, it causes anxiety. They're worried — is this the time it's going to go up?"

A big part of active surveillance, however, is working with your care team to determine if and when treatment is necessary.

"We're actively monitoring [patients]," says George R. Schade, MD, an associate professor of urology at UW Medicine and Fred Hutchinson Cancer Center in Seattle. "If in the future the cancer looks like it may benefit from treatment, we would then step in and transition to an active treatment."

1. Understand the Benefits and Risks

"A big part of stress with cancer diagnoses is the lack of control," Dr. Schade says.

You may feel more in control if you fully understand the benefits and risks of active surveillance. Have an honest discussion with your doctor. Learn about your other options. Ask questions. Share your preferences. And become an active participant in making decisions about your care, Dr. Khera says.

2. Focus on Things You Can Control

Simple things you do every day to improve your health can help you feel more in control. Khera calls them the "four pillars":

1. Diet
2. Exercise
3. Sleep
4. Stress reduction

Do not forget to pay attention to any other health issues you might have, as well, in addition to screening for other cancers.

3. Practice Mindfulness

Techniques such as meditation and deep breathing are designed to take your mind off your worries, focus it on the present moment, and help you accept your thoughts and feelings.

"Mindfulness is phenomenal for reducing stress," Khera says.

4. Get Support

Surround yourself with people who care about you and are willing to help when you feel anxious. Your support circle could include your partner, friends, and family.

Support groups are another good resource where you can find people on active surveillance or those who have undergone treatment and encountered side effects.

"Being able to talk to other men who are going through the same thing or have been through the same thing could be really helpful," Schade says.

Prostate cancer support groups are available at cancer centers and through organizations such as:

• AnCan
• Prostate Cancer Foundation
• ZERO Prostate Cancer
• CancerCare

5. Involve Your Partner

Your partner may feel anxiety, too, worrying with every test result that your cancer has progressed. The same is true for other family members and close friends.

6. Keep Up With Appointments

Active surveillance doesn't mean doing nothing. It often comes with regular testing and follow-up schedules. It’s important to keep your doctor appointments to ensure your condition is staying within a safe limit.

• A prostate-specific antigen (PSA) blood test every six months
• A digital rectal exam (DRE) once a year
• Prostate biopsy and imaging tests every one to three years

"We keep a close eye on the cancer," Schade says. "If we find something that looks more concerning or if the patient opts to be more aggressive, then we would transition to treatment."

7. Adopt a Positive Attitude

"Healthier attitudes can help people get through cancer better," Khera says.

Khera recommends talking to your doctor if you:

• Have trouble sleeping
• Feel uneasy or panicked
• Can't concentrate
• Can't control feelings of worry
• Are unable to sit still
• Feel short of breath
• Have a fast heart rate

You can start with your oncologist, who may refer you to a therapist or other mental healthcare providers who work with people with cancer.

• Active surveillance, or monitoring your lower-risk prostate cancer without treating it right away, can cause anxiety and feelings of losing control.
• Coping strategies include a healthy diet, exercise, adequate sleep, stress reduction, and mindfulness techniques.
• It’s important to keep up with your doctor appointments during active surveillance, and to keep your family in the loop to help manage their anxiety.
• Mental health support can be helpful. Talk to your doctor if your anxiety causes you to lose sleep, feel unable to control your feelings of worry, or have additional health issues.