More men than ever are living for many years after a prostate cancer diagnosis. Alongside the physical effects of treatment, many experience worry that the cancer will return, or anxiety each time a PSA test is due. A systematic review published in Supportive Care in Cancer looked at how common these feelings are. This article summarises its findings on PSA anxiety and fear of recurrence, and what they mean for patients.
Why this matters
Prostate cancer is the most commonly diagnosed cancer in men in Europe, and ten-year survival now reaches around 80%. Wider PSA testing means more cancers are found at an early, localised stage. As a result, prostate cancer is increasingly seen as a long-term condition that many men live with, rather than a short illness.
That shift brings mental wellbeing into focus. Our article on mental health and prostate cancer describes Professor Dasgupta's view that caring for the mind is as important as treating the disease.
Two common worries
The review focused on two related experiences.
Fear of cancer recurrence
This is a persistent worry that the cancer will come back or progress, even after successful treatment.
PSA anxiety
PSA tests are the main way of monitoring prostate cancer after treatment. For some men, the period before each test, and waiting for the result, brings significant anxiety.
How the review was carried out
Two independent reviewers searched three major medical databases. Of 1,148 records screened, 32 studies met the criteria, all using validated questionnaires to measure fear of recurrence or PSA anxiety. Each study was assessed for quality, and those with a high risk of bias were excluded. Because the studies varied in design, the findings were combined in a structured summary rather than a single statistical analysis. This approach is common when research uses different questionnaires and follows patients over different periods.
What the review found
Across the studies, the median proportion of men with significant fear of recurrence was 16%, and the proportion with significant PSA anxiety was 22%.
Studies that followed men over time showed that both worries tend to peak at diagnosis and then change little, even several years later. Younger age, poorer general quality of life and other mental health symptoms were linked to higher levels of both. Few studies looked at whether the type of treatment or the stage of the cancer made a difference, so more research is needed to understand who is most at risk and when support is most useful.
What the authors recommend
The review concluded that fear of recurrence and PSA anxiety are prominent problems for men with prostate cancer, and that they are associated with poorer quality of life and mental health. The authors recommend that checking for these worries, and referring men to appropriate support, should become part of routine follow-up care.
If you recognise these feelings
Feeling anxious about PSA tests or the cancer returning is common and understandable. Things that can help include:
- asking your team how and when results will be shared, so that waiting is shorter
- talking openly with your partner, family or specialist nurse
- asking about counselling or psychological support
- keeping active and maintaining routines that help you feel well
Prostate Cancer UK offers a specialist nurse helpline and support services, and the NHS provides talking therapies that you can refer yourself to.
Understanding PSA results
Knowing what PSA results mean can also reduce uncertainty. Our guide to results after prostate cancer surgery explains PSA after treatment, and our overview of prostate cancer covers the condition more broadly. Our recovery guide also discusses the emotional side of recovery.
If worry about your PSA results is affecting your wellbeing, please contact the clinic to discuss your follow-up and support.