Fear of Cancer Recurrence and PSA Anxiety in Patients with Prostate Cancer: A Systematic Review

Callum James, Oliver Brunckhorst*, Omar Eymech, Robert Stewart, Prokar Dasgupta, Kamran Ahmed

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
31 Downloads (Pure)


The impact of prostate cancer on the mental wellbeing of patients is increasingly being appreciated. Two important aspects of this include fear of cancer recurrence (FCR) and prostate-specific antigen (PSA) anxiety. However, their prevalence, severity and associating factors remain poorly understood. Therefore, this review aims to evaluate the current evidence for the prevalence, severity and associating features of PSA anxiety and FCR.

A systematic search of MEDLINE, EMBASE and PsycINFO databases was conducted by two independent reviewers. Observational studies measuring FCR and PSA anxiety in prostate cancer using validated measures were included. Outcome measures were prevalence of significant levels, mean scores and significant correlations of FCR and PSA anxiety scores with patient, disease, treatment or other mental health and quality of life outcomes.

One thousand one hundred forty-eight individual records underwent screening with 32 studies included. Median prevalence of significant FCR and PSA anxiety was 16% and 22% respectively across all studies. Longitudinal studies demonstrated severity of both symptoms peaks at diagnosis, with little variability, even several years following this. Evaluating associating factors revealed younger age, generalised quality of life and mental health symptoms to be important factors for both outcomes. Few studies evaluated associations and differences between other patient, disease and treatment characteristics.

FCR and PSA anxiety are prominent symptoms for prostate cancer patients and importantly when present, are associated with poorer quality of life and mental health symptoms. Screening for these constructs and referral to appropriate services should form part of routine follow-up care.
Original languageEnglish
Pages (from-to)5577-5589
Number of pages13
JournalSupportive Care in Cancer
Issue number7
Early online date1 Feb 2022
Publication statusPublished - 1 Feb 2022


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