15250-m-cuypers

57 HRQoL changes prior to Pca treatment onset 3 present from diagnosis onwards. In our results, reduced role functioning and increased sexual functioning (compensatory behavior) could be indicative for the presence of a masculinity threat 40, 41 . 4.2 Personality factors Optimism and decisional self-efficacy were associated with better global health, this is in line with previous research that found optimism and decisional self-efficacy to be associated with less distress and better coping 21, 42 . In the current study, patients scoring higher on optimism report better HRQoL prior to biopsy, when Pca was suspected but not yet confirmed.. After diagnosis, and a treatment decision was required, optimism seemed to play less of a role and decisional self-efficacy, the subjective feeling of being able to take the right action, making good decisions and to ask questions, was positively associated to HRQoL. This adds to previous findings about knowledgeable (and therefore possibly more self-efficated) patients reporting better HRQoL 43 . Instead of focusing on a single trait (e.g. neuroticism), this study investigated a broader spectrum of the big five personality traits. At t0, extraversion and neuroticism were related to global health, while at t1 no relations were present anymore. Hence, we found no evidence of a moderating role of specific traits affecting changes in HRQoL. Another explanation could be that the brief measure we used was not sensitive enough to also detect statistically significant differences in the smaller t1 sample. Future studies should use more extensive measures to investigate this relation in more detail. 4.3 Study limitations Some limitations need to be discussed. First, no detailed clinical data about tumor stage was available, and PSA was self-reported by participants. However, patients were only eligible for inclusion if Pca was suspected, following pre-biopsy screening (rectal examination and PSA testing). Therefore, we were still able to sample a homogeneous patient population. And although we had no registration of the number of patients refusing participation, the average Pca detection rate in our sample was similar to what was expected based on literature 5 . Secondly, drop-out of men without Pca diagnosis and non-response at t1 led to a limited number of patients per treatment group available for further analyses. Moreover, the comparison between t1 and t0 on group level had sufficient power, however, the subgroup comparisons were lacking power. As we found no statistically significant differences in patient characteristics between responders and non-responders, we estimate the risk for selection bias was low. Our results should therefore be seen as exploratory findings on the development of HRQoL in Pca patients with a pre-diagnosis baseline. Follow-up studies preferably use larger samples.