Postulate 5: the psychological burden of untreated cancer

The psychological burden of living with untreated cancer has less impact on the quality of life than unnecessary, but curative, therapy. The psychological effects of living for many years with untreated cancer are unknown; however, the evidence indicates it is the diagnosis of cancer that takes a psychological toll, whether patients are treated curatively or not. A companion study to the randomized trial of surgery versus watchful waiting in Sweden described above found no significant psychological difference at 5 years between the two study arms. The occurrence of worry, anxiety or depression was equal between the treatment and the observation arms. Surveillance is clearly stressful for some men; however, concern about PSA recurrence is common among both treated and untreated patients. Patients who are educated to appreciate the indolent natural history of most good-risk prostate cancers might avoid much of this anxiety. Further quality-of-life studies focusing on this issue are clearly warranted.