Skip to content
Medical InsightsKoreaMedical Insights Korea

Prostate

Is living with an untreated prostate cancer under active surveillance stressful?

A Korean study measured something most trials do not: how often men under monitoring were newly started on antidepressants, compared with men who had been treated.

By

Reporter

Published
Reading time
5 minutes

Answer

Korean national data suggest it carries a real psychological cost: in a target trial emulation matching men with localised prostate cancer, those who had surgery or radiotherapy were less likely to start antidepressants than matched men under surveillance — hazard ratios of 0.73 (95% CI 0.58 to 0.93) for surgery and 0.38 (0.24 to 0.61) for radiotherapy — over a mean follow-up of 4.4 years.

Key takeaways

  • A Korean target trial emulation linked national insurance, cancer registry and death registry data, matching 1,191 men having radical prostatectomy against 1,191 under surveillance, and 428 having radiotherapy against 428 under surveillance.
  • Men who had surgery were less likely to start antidepressants than matched men under surveillance: hazard ratio 0.73 (95% CI 0.58 to 0.93).
  • Men who had radiotherapy were considerably less likely again: hazard ratio 0.38 (95% CI 0.24 to 0.61).
  • Over a mean follow-up of 4.4 years there were 2 prostate cancer deaths in the surgery group and 2 in its matched surveillance group, and 3 in the radiotherapy group against 1 in its matched surveillance group.
  • With four prostate cancer deaths in total across the surgery comparison, the study cannot distinguish the treatments on mortality — its finding of comparable risk is an absence of evidence rather than evidence of equivalence.
  • In the ProtecT randomised trial, active monitoring avoided the sexual and urinary harms that surgery caused and the bowel effects that radiotherapy caused.
  • About 24.3 percent of newly diagnosed Korean men are eligible for active surveillance under a broad definition, and that share fell from 27.6 percent in 2010 to 22.0 percent in 2020.

Active surveillance asks a man to live with a diagnosed cancer that is not being treated. The clinical case for it is strong for low-risk disease, and it is usually presented as the option with no side effects. A Korean study looked for a cost that no toxicity scale records.

What was measured

A target trial emulation published in Discover Oncology linked Korea's national insurance data to the cancer registry and the death registry, then constructed matched comparisons: 1,191 men having radical prostatectomy against 1,191 under surveillance, and 428 having radiotherapy against 428 under surveillance.

Starting an antidepressant, treated versus matched men under surveillance
ComparisonHazard ratio (95% CI)
Radical prostatectomy vs surveillance0.73 (0.58–0.93)
Radiotherapy vs surveillance0.38 (0.24–0.61)

Both hazard ratios are below 1, meaning treated men were less likely to be newly prescribed an antidepressant than men being monitored. Over a mean follow-up of 4.4 years, that difference persisted.

The other side of the ledger

Surveillance exists because treatment costs something too. In the ProtecT randomised trial, surgery had the greatest negative effect on urinary continence and sexual function, and radiotherapy damaged bowel function, with bloody stools becoming more frequent over six years rather than settling. Men under active monitoring avoided both.

So the comparison is not between a harmless option and a harmful one. It is between physical harms that are well documented and a psychological cost that is rarely quantified — and this study is one of the few attempts to put a number on the second.

What the study cannot settle

The mortality comparison in the same study is worth reading carefully, because it is the part most likely to be over-quoted. Over 4.4 years there were 2 prostate cancer deaths in the surgery group and 2 among matched men under surveillance; 3 in the radiotherapy group against 1 among its matched controls.

Four prostate cancer deaths across the entire surgery comparison cannot distinguish two treatments. The study's finding of comparable mortality risk is an absence of evidence, not evidence of equivalence, and 4.4 years is short for a cancer measured over decades.

For a Korean man being offered surveillance, the practical reading is that the option is not psychologically free, that this is a known and named cost rather than a personal failing, and that it is worth saying out loud at the appointment where the choice is made.

Sources

  1. 1

    An MH, Kim C, Min K, Yi KH, Park RW, Jung M

    Target trial emulation of survival outcomes for clinically localized prostate cancer treatments

    Discover Oncology 2026;17(1):1208

    doi:10.1007/s12672-026-05392-4 · PMID:42286375

    https://doi.org/10.1007/s12672-026-05392-4
  2. 2

    Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al.

    Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer

    New England Journal of Medicine 2016;375(15):1425-1437

    doi:10.1056/nejmoa1606221 · PMID:27626365

    https://doi.org/10.1056/nejmoa1606221
  3. 3

    Ko YH, Kim SW, Son NH

    Active surveillance could apply to one-quarter of Korean prostate cancer cases: insights from a 27,075-patient cohort

    Prostate International 2026;14(2):127-131

    doi:10.1016/j.prnil.2025.12.004 · PMID:42382553

    https://doi.org/10.1016/j.prnil.2025.12.004