EURURO Vol. 73 No. 1

143 148

Conflicts of interest: The authors have nothing to disclose.
References
[1]
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[2]
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[3]
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[4]
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[5]
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Vito Pansadoro, Aldo Brassetti*
Fondazione Vincenzo Pansadoro, Centro di Urologia Laparoscopica e
Oncologia Medica, Rome, Italy
*Corresponding author. Fondazione Vincenzo Pansadoro, Centro di
Urologia Laparoscopica e Oncologia Medica, Via Aurelia, 559, Rome
00165, Italy. Tel. +39 340 8720014; Fax: +39 063 3775428.
E-mail address: (A. Brassetti).
© 2017 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
Re: Long-term Psychological and Quality-of-life Effects
of Active Surveillance and Watchful Waiting After
Diagnosis of Low-risk Localised Prostate Cancer
Egger S, Calopedos R, O’Connell D, Chambers SK, Woo HH,
Smith DP
Eur Urol. In press.
Experts’ summary:
Egger et al [1] performed a 10-yr cohort study among
52–79-yr-old men diagnosed with low-risk localized pros-
tate cancer. The objective of this research was to test per-
manent psychological and quality-of-life effects after active
surveillance/watchful waiting and other specific active treat-
ments.
Using several validated questionnaires and protocols, a
total of 582 patients were interviewed and results of 341
(59%) of themwere recorded. This research analyzed nine
mental conditions and six quality-of-life states. Despite
minor differences in psychological domains, particularly
in bowel bother, hyperarousal, avoidance, distress, and
urinary incontinence, no significant disparities were
detected.
Experts’ comments:
There are several factors that may considerably affect the
results of the study such as ethnicity, marital status and
employment status of the participants. First is genetic predis-
position, as cancer heterogeneity varies from nation to nation
due to certain hot spots on chromosomal locus such as 17q21
variants [2] . Since these variants are also responsible for major
depressive disorder (MDD), it is uncertainwhether to consider
psychological outcome as a result of either postprostate can-
cer syndrome or MDD.
A vast majority of surveyed men were also married
(about 80%), which puts this criterion into debate. Accord-
ing to a study [3] conducted in the USA, on the distress scale,
married couples experience comparatively less stress owing
to agreement, trust, and support between partners. In
contrast, single men experience stress in relationship issues
as they are concerned about when they need to bring up the
fact about sexual difficulties. However, there are families
with high and low partner support, which should also be
considered as a determining factor of measuring distress
level.
In addition, more than the half (69%) of the interviewed
individuals belonged to the category of retired/unemployed
people. This is critical, as unemployed cancer patients are
two times more susceptible to anxiety, mostly due to health
insurance [4]. Moreover, it was demonstrated that unin-
sured cancer patients have a 40% higher mortality risk,
which might be the reflection of employer-based health
system in the USA [5]. Furthermore, it was found that the
survival rate among low-income cancer patients is higher in
Canada than in the USA, because in Canada the health
system provides equal access to essential medical proce-
dures [5]. Since possessing a job is directly linked to
obtaining the insurance in the USA, financial problems of
unemployed prostate cancer patients without an insurance
could have facilitated an increase in anxiety and worsened
physical conditions.
We praise Egger et al [1] for addressing a critical question
regarding the proper prostate cancer treatment. Unfortu-
nately, owing to the complications discussed previously, we
are concerned about various sociodemographic factors
challenging the outcomes of tests. Therefore, for a future
avenue we would suggest taking that into account and
testing a larger and diverse population with better
characteristics.
Conflicts of interest: The authors have nothing to disclose.
References
[1] Egger S, Calopedos R, O’Connell D, Chambers SK, Woo HH, Smith DP.
Long-term psychological and quality-of-life effects of active sur-
veillance and watchful waiting after diagnosis of low-risk localised
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