Objective: Identifying which men with prostate cancer might benefit from mental health treatment has proven to be a challenging task. We developed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) (Roth, et al., 2003) in order to facilitate the identification of prostate cancer-related anxiety. A revised version of the scale was tested in a more clinically varied population, and consists of three subscales measuring general prostate cancer anxiety, PSA anxiety, and fear of recurrence. Analysis compared men with early vs. late stage disease to determine if the nature of anxiety differed between stages.
Methods: Ambulatory men with prostate cancer (n=367) were recruited from genitourinary clinics at Memorial Sloan-Kettering Cancer Center. Prior to routine Prostate Specific Antigen (PSA) tests, participants completed a ‘‘baseline’’ assessment packet that included the Hospital Anxiety and Depression Scale, the Distress Thermometer, the Functional Assessment of Cancer Therapy Scale, Prostate Module, Generalized Anxiety Disorder Questionnaire, and a measure of urinary functioning. Follow-up evaluation was completed by mail two weeks after patients learned of their PSA test result.
Results: Analysis of the MAX-PC revised revealed a high degree of internal consistency (Alpha=.90) and good inter-item reliability for the total score and the three subscales (MAXPCA Alpha=.90, MAXPC fear of recurrence Alpha=.85), although reliability was somewhat weaker for the PSA Anxiety scale (Alpha=.55). Concurrent validity was demonstrated by correlations between the MAX-PC and other measures of anxiety. Factor analysis with MAX-PC indicates three distinct factor loadings for the MAX-PC subscales. Men with early stage disease seemed to have more diffused anxiety, whereas the distinction between subscales appeared more relevant for those with advanced cancer.
Conclusion: The revised MAX-PC appears to be a valid and reliable measure of anxiety in men with prostate cancer.