Urologic Oncology: Seminars and Original Investigations ] (2018) ∎∎∎–∎∎∎ Original article Psychological and functional effect of different primary treatments for prostate cancer: A comparative prospective analysis Alessandro Sciarra, M.D. a , Alessandro Gentilucci, M.D. a , Stefano Salciccia, M.D. a , Magnus Von Heland, M.D. a , Giam Piero Ricciuti, M.D. a , Vittorio Marzio, M.D. a , Federico Pierella, M.D. a , Daniela Musio, M.D. b , Vincenzo Tombolini, M.D. b , Viviana Frantellizzi, M.D. c , Massimo Pasquini, M.D. d , Annalisa Maraone, M.D. d , Alessio Guandalini, Ph.D. e , Martina Maggi, M.D. a, * a Department of Urological Sciences, University Sapienza, Rome, Italy b Department of Radiotherapy, University Sapienza, Rome, Italy c Department of Radiological Sciences, University Sapienza, Rome, Italy d Department of Neurology and Psychiatry, University Sapienza, Rome, Italy e Department of Statistics, ISTAT, Rome, Italy Received 26 December 2017; received in revised form 26 February 2018; accepted 31 March 2018 Abstract Objectives: The aim of the study was to comparatively evaluate the psychological and functional effect of different primary treatments in patients with prostate cancer. Methods and materials: We conducted a single-center prospective non randomized study in a real-life setting using functional and psychological questionnaires in prostate cancer cases submitted to radical prostatectomy, external radiotherapy, or active surveillance. Totally, 220 cases were evaluated at baseline and during the follow-up at 1-, 3-, 6-, and 12-month interval after therapy. Patients self- completed questionnaires on urinary symptoms and incontinence, erectile and bowel function, psychological distress (PD), anxiety, and depression. Results: Several significant differences among the three groups of treatment were found regarding the total score of the functional questionnaires. Regarding PD, cases submitted to radical prostatectomy showed stable scores during all the 12 months of follow-up whereas cases submitted to radiotherapy showed a rapid significant worsening of scores at 1-month interval and persistent also at 6- and 12-month interval. Cases submitted to active surveillance showed a slight and slow worsening of scores only at 12-month interval. PD and depression resulted to be more associated with urinary symptoms than sexual function worsening whereas anxiety resulted to be associated either with urinary symptoms or sexual function worsening. Conclusions: The results of our comparative and prospective analysis could be used to better inform treatment decision-making. Patients and their teams might wish to know how functional and psychological aspects may differently be influenced by treatment choice. r 2018 Elsevier Inc. All rights reserved. Keywords: Prostate neoplasm; Radical prostatectomy; Active surveillance; Radiotherapy; Psychological distress 1. Introduction Cancer diagnosis represents a potential challenge for patients’ psychological adjustment [1]. Psychological distress (PD) is a well-recognized phenomenon connected with cancer diagnosis and the most common forms of PD are anxiety and depression [2–6]. The aim of the study was to comparatively and pro- spectively evaluate in a real-life setting the psychological and functional effect of different primary treatments in patients with prostate cancer (PC) and no evidence of https://doi.org/10.1016/j.urolonc.2018.03.022 1078-1439/r 2018 Elsevier Inc. All rights reserved. * Corresponding author. E-mail address: alessandro.sciarra@uniroma1.it (M. Maggi).