Objective: To investigate the prevalence of decision-making conflict in prostate cancer patients and its relationship with anxiety and depressive symptoms, as well as to identify independent risk factors for high levels of decision-making conflict. Methods: A convenience sampling approach was employed to enroll 251 newly diagnosed prostate cancer patients. Cross-sectional surveys were conducted using a general information questionnaire, Decision Conflict Scale (DCS), Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire Depression Scale (PHQ-9). Patients were divided into a low-risk group and a high-risk group based on a DCS score cutoff of 37.5 points. Univariate analysis and binary logistic regression were performed to examine influencing factors of high decision-making conflict. Results: Among the 251 patients, the incidence of high decision-making conflict was 31.1% (78/251). Univariate analysis revealed that age, highest educational attainment, marital status, employment status, alcohol consumption, clinical stage of cancer, as well as levels of anxiety and depression were significantly associated with high decision-making conflict (P < 0.05). Binary logistic regression identified total depression score (OR = 1.252; 95% CI: 1.074 - 1.459; P = 0.004) as an independent risk factor for high decision-making conflict, whereas total anxiety score showed no statistical significance (P > 0.05). Conclusion: Prostate cancer patients exhibit a high prevalence of decision-making conflict. Compared to anxiety, depressive symptoms more specifically predict the risk of high decision-making conflict. Clinical practice should prioritize screening for depressive symptoms and provide targeted decision-making counseling and psychological support.
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