Coping with anxiety on Active Surveillance is an important part of living well with prostate cancer. In this ASPI educational session, Dr. John Oliffe explores anxiety, emotional distress, and the strain of living with uncertainty while monitoring low-risk disease.
Stress can build around PSA tests, MRIs, biopsies, follow-up appointments, and especially the wait for results. Dr. Oliffe explains that anxiety does not always look like obvious worry. It may show up as irritability, anger, withdrawal, restlessness, or simply saying “I’m stressed” rather than “I’m anxious.”
He also shares practical ways men can cope more effectively, including building support before a crisis, considering talk therapy, mapping what drains and boosts you, planning ahead for PSA-related pressure points, and using connection and peer support to reduce isolation.
Follow along with Dr. Oliffe’s slides by downloading them here:
A prostatectomy doesn’t cure anxiety
Why Active Surveillance Anxiety Matters
Dr. Oliffe explains that anxiety is closely tied to uncertainty about the future, which makes it especially relevant for men on Active Surveillance. Living with a known cancer while choosing monitoring instead of immediate treatment can create ongoing emotional strain, particularly when others around you may urge a more aggressive path.
ASPI’s introduction to the session noted that in a survey of 450 men on Active Surveillance through ASPI, ANCAN, and other support groups in Canada, more than 50% reported anxiety or other emotional distress, and 10% said they were stressed enough to consider treatment even though they were still good candidates for surveillance.
How Active Surveillance Anxiety May Show Up in Men
One of the key themes in this session is that men may not always talk about anxiety directly. Dr. Oliffe discusses how it can appear through:
- Irritability, anger, or restlessness
- Withdrawal, silence, or isolation
- Saying “I’m stressed” rather than naming anxiety directly
- Changes in patience, mood, or behavior around PSA checks and follow-up appointments
He also distinguishes anxiety, depression, and suicidality, and explains how self-reliance, stigma, and emotional restraint can make it harder for men to recognize what they are feeling or ask for help.
Practical Strategies for Coping and Support
Dr. Oliffe emphasizes that there are practical ways to manage anxiety more effectively. He encourages men to:
- Notice what drains them and what boosts them
- Build one positive activity into the week as a non-negotiable
- Plan ahead for known pressure points, such as PSA testing
- Consider talk therapy before reaching a crisis point
- Use exercise, routine, and connection as practical mental health tools
He also introduces a simple framework for supporting other men: ALEC:
- Ask
- Listen
- Encourage action
- Check back
The talk also highlights the importance of support groups, where men can share experience, learn from one another, and realize they are not alone.
Watch the Discussion
Chapters
- 00:00 – Welcome, ASPI notes, and meeting introductions
- 06:20 – Why anxiety matters on Active Surveillance
- 09:29 – Speaker introduction and opening remarks
- 18:22 – Anxiety, uncertainty, and how men may experience it
- 23:59 – What research shows about anxiety on Active Surveillance
- 25:08 – Anxiety vs. depression vs. suicidality
- 37:45 – Practical coping strategies and emotional regulation
- 44:30 – Why support groups and social connection matter
- 46:58 – The ALEC framework for helping other men
- 53:51 – Building routines and planning for pressure points
- 1:00:42 – Live Q&A with ASPI participants
About the Speaker
Dr. John Oliffe is Professor and Canada Research Chair in Men’s Health Promotion at the University of British Columbia, where he leads the Men’s Health Research Program.
For more than two decades, his work has focused on men’s mental health, prostate cancer, support groups, masculinity, and how men cope with illness, uncertainty, and emotional distress. His research has helped illuminate the less visible side of prostate cancer, including how anxiety may shape identity, relationships, decision-making, and quality of life.
Related ASPI Resources for Anxiety & Emotional Wellbeing
- Visit the ASPI Relaxation Room for calming videos and music created for men on Active Surveillance.
- Watch Compassionate Care: Reducing Anxiety for more on how support and compassionate care can ease distress.
- Explore ASPI’s Short Video Library for expert clips on mental health, coping, and life on Active Surveillance.
- Read Coping Strategies for Men on Active Surveillance for practical ideas on support, routine, counselling, and relaxation practices.
- Read Understanding Your PSA Levels: What Do They Mean? for a patient-friendly look at PSA fluctuations and the worry they can trigger.
- If you need more support, contact ASPI or speak with your clinician about counselling, CBT, psycho-oncology, or support groups.