How badly did it hit? Self-assessed emotional shock upon prostate cancer diagnosis and psychological well-being: a follow-up at 3, 12, and 24 months after surgery

Figures & data

Figure 1. Flow chart for the analysis of self-assessed emotional shock and psychological well-being from the LAPPRO trial.

Table 1. Characteristics of patients treated with radical prostatectomy (n = 3232).

Characteristics^a	Emotionally shocked N (%) (n = 2426)^b	Not emotionally shocked N (%) (n = 806)^b	p value	The full LAPPRO cohort N (%) (n = 3706)
Age at surgery
Median	63	64	<.0001	63
Range	37–79	40–77		37–79
Interquartile range (IQR)	58–67	60–67		59–67
Educational level (years in school)
Primary school (≤9 yrs)	457 (19)	138 (17)	.006	601 (16)
Secondary school (10–12 yrs)	727 (30)	224 (28)		956 (26)
Practical training school (12–13 yrs)	307 (13)	81 (10)		391 (26)
University/College (>13 yrs)	874 (36)	349 (43)		1233 (33)
Other	43 (2)	11 (1)		55 (2)
Not stated	18 (1)	3 (<1)		21 (<1)
Employment status^c
Primarily employed	1301 (54)	391 (49)	.01	1702 (46)
Primarily retired	962 (40)	369 (46)		1345 (36)
Primarily on sick leave	24 (1)	3 (<1)		27 (<1)
Other	139 (6)	43 (5)		183 (5)
Marital status
Married/cohabiting	2020 (84)	688 (86)	.47	2731 (74)
In relationship but lives alone	172 (7)	50 (6)		223 (6)
Single	185 (8)	53 (7)		239 (6)
Widower	30 (1)	13 (2)		43 (1)
Alcohol binge drinking^d
<Once a week	2186 (94)	750 (97)	.002	3337 (90)
≥Once a week	144 (6)	25 (3)		194 (5)
Type of surgery^e
Open	612 (25)	192 (24)	.42	942 (25)
Robot assisted laparoscopic	1814 (75)	614 (76)		2764 (75)
Clinical tumor stage, preoperatively^e
T1	1383 (59)	519 (66)	.0002	2171 (60)
T2	879 (37)	254 (32)		1303 (36)
T3	98 (4)	15 (2)		120 (3)
Gleason score, preoperative biopsy^e
≤7	2251 (93)	764 (95)	.05	3449 (94)
≥8	160 (7)	38 (5)		224 (6)
Antidepressant medication use
No	2247 (96)	753 (97)	.39	3409 (92)
Yes	94 (4)	26 (3)		137 (4)
Not stated	8 (<1)	1 (<1)		11 (<1)
Anxiety in the past month^f
0 Never	704 (30)	471 (60)	<.0001	1323 (36)
1	667 (28)	160 (21)		922 (25)
2	370 (16)	69 (9)		507 (14)
3	278 (12)	47 (6)		376 (10)
4	224 (10)	25 (3)		290 (8)
5	88 (4)	6 (1)		112 (3)
6 All the time	15 (1)	2 (<1)		20 (<1)
Not stated	3 (<1)	0 (0)		7 (<1)
Anyone to confide in
No one	170 (7)	57 (7)	.40	270 (7)
1 person	930 (40)	288 (37)		1372 (37)
More than one	1242 (53)	433 (56)		1902 (51)
Pad changing requirement due to urinary leakage
No pad required/<1/day	1109 (47)	364 (47)	.80	1659 (45)
≥1/day	1229 (53)	412 (53)		1883 (51)
Sexual dysfunction
<50% of the time	1961 (84)	649 (85)	.84	2966 (80)
≥50% of the time	365 (16)	118 (15)		547 (15)
Active surveillance
No	2074 (88)	672 (85)	.02	3137 (88)
Yes	281 (12)	119 (15)		447 (12)

^aData given as a number (percentage) unless indicated otherwise. Numbers do not add up due to rounding. For some variables, numbers do not add up due to missing values.

^bNumbers do not add up to 100% due to missing responses.

^cPossibility to mark more than one response. Hence, the numbers may not add to 100%.

^dAlcohol equal to six glasses or more on one occasion during the past month.

^eInformation extracted from clinical record form (CRF).

^f0–1 = never/sometimes; 2–6 = often/all the time.

Figure 2. Potentially modifiable psychosocial independent variables of psychological well-being (outcome) at 3, 12, and 24 months after surgery among self-assessed emotionally shocked patients (n = 2426).

Table 2. Relative risks of self-assessed emotional shock upon diagnosis on low compared with high psychological well-being at 3, 12, and 24 months after radical prostatectomy.

	N (%)^a	RR (95% CI)	OR (95%CI)	Adjusted OR (95% CI)^b
Low psychological well-being at 3 months^c
Self-assessed emotionally shocked
Yes	1038/2344 (44)	1.6 (1.4–1.8)	2.1 (1.8–2.5)	1.7 (1.4–2.0)
No	213/779 (27)	1.0 (Ref.)	1.0 (Ref.)	1.0 (Ref.)
Low psychological well-being at 12 months^c
Self-assessed emotionally shocked
Yes	839/2271 (37)	1.6 (1.4–1.8)	1.9 (1.6–2.3)	1.3 (1.1–1.7)
No	183/772 (24)	1.0 (Ref.)	1.0 (Ref.)	1.0 (Ref.)
Low psychological well-being at 24 months^c
Self-assessed emotionally shocked
Yes	838/2214 (38)	1.4 (1.3–1.6)	1.7 (1.4–2.0)	1.4 (1.1–1.8)
No	198/752 (26)	1.0 (Ref.)	1.0 (Ref.)	1.0 (Ref.)

ASA score: American Society of Anesthesiologists score; CI: confidence interval; RR: relative risk.

^aNumbers do not add up due to missing responses.

^bRelative risks adjusted for age, marital status, educational level, alcohol drinking, surgery type, ASA score, perceived available social support, anxiety, feelings of depression, erectile dysfunction urinary leakage, and biochemical recurrence at each time point (3, 12, and 24 months). Biochemical recurrence = PSA >0.25 or chemotherapy, hormone treatment, radiotherapy treatment.

^cPsychological well-being shown on a 0–6 visual digital scale (VDS): low, 0–4; high, 5–6.

Table 3. Relative risks of self-assessed emotional shock in relation to tumor characteristics.

	Emotionally shocked patients N (%)^a	RR (95% CI)
Clinical tumor stage, preoperatively
T3	98/113 (87)	1.2 (1.1–1.3)
T1/T2	2262/3035 (75)	1.0 (Ref.)
Gleason score, preoperative biopsy
≥8	160/198 (81)	1.1 (1.0–1.2)
≤7	2251/3015 (75)	1.0 (Ref.)
Prostate-specific Antigen (PSA)^b
≥9.2	610/821 (74)	1.0 (0.9–1.0)
6.2–9.1	600/806 (74)	1.0 (0.9–1.0)
4.5–6.1	616/821 (75)	1.0 (0.9–1.0)
<4.5	591/770 (77))	1.0 (Ref.)
Tumor in millimeters^c
≥16	607/770 (79)	1.1 (1.1–1.2)
7.7–15.9	551/731 (75)	1.1 (1.0–1.1)
3.8–7.6	549/733 (75)	1.1 (1.0–1.1)
<3.8	525/747 (70)	1.0 (Ref.)
ASA score^b^,^d
III–IV	49/65 (75)	1.0 (0.9–1.2)
I–II	2310/3086 (75)
d’Amico^e
High	298/361 (83)	1.1 (1.1–1.2)
Medium	1439/1930 (75)	1.0 (1.0–1.0)
Low	656/895 (73)	1.0 (Ref.)

CI: confidence interval; No: number; RR: relative risk. Information extracted from clinical record form (CRF).

^aNumbers do not add up due to missing responses.

^b 1 = healthy patient; 2 = mild systemic disease; 3 = severe systemic disease.

^cQuartiles.

^dASA = American Society of Anesthesiologists.

^eLow = Gleason score =4-6 and PSA <10 and cT stage = T1.

Medium = Gleason score =7 or 10 or PSA <20 or cT stage = T2.

High = Gleason score =8–11 or PSA >20 or cT stage = T3/T4.