High Rates of Significant Depression Identified in Prostate Cancer

Contemporary Concepts | Contemporary Concepts in Prostate Cancer | <b>Management of Psychosocial Concerns</b>

Patients with prostate cancer commonly have significant depression, highlighting a need for screenings in those with poor social determinants of health, concomitant disability, and advanced disease.

Patients with prostate cancer are at an increased risk of developing significant depression investigators highlighting a need to conduct screenings in those with poor social determinants of health, concomitant disability, and advanced disease, according to a study published in the Canadian Urological Association Journal.

According to investigators, independent risk factors for depression included younger age (odds ratio [OR] 1.38; 95% CI, 1.16-1.60 per 10-year decrease), being a current smoker (OR, 2.77; 95% CI, 1.66-4.58), previous alcohol use (OR, 2.63; 95% CI, 1.33-5.20), poor performance status (OR, 5.01; 95% CI, 3.49-7.20), having a pre-existing clinical diagnosis of depression or anxiety (OR, 3.64; 95% CI, 2.42-5.48), and having high-risk prostate cancer (OR, 1.49; 95% CI, 1.05-2.12). Every 10-year decrease in age resulted in a 38% increase in depression. Current smoking and alcohol use each yielded a 3-fold increase in depression, respectively, and the inability to perform work activities yielded a 5-fold increase. High-risk prostate cancer was associated with a 49% increase. Those who had a history of anxiety or depression had approximately a 4-fold increase in exhibiting depression.

“Our study examined the prevalence and predictors of depression in a large, contemporary, prospectively collected sample of men with prostate cancer. In this sample, we report an overall point prevalence of depression of 8%. This is lower than many previously quoted prevalence rates, but still elevated relative to general population estimates,” the investigators wrote.

A total of 2445 patients were included in the study, of whom 2263 had been diagnosed with prostate cancer within the last 12 months. Patients had a mean age of 68 years, and the majority were White and had a good performance status. Approximately half of all patients with localized disease had high-risk prostate cancer, 7% had a history of metastatic disease, and 11% had a history with a clinical diagnosis of depression or anxiety.

In the overall population, 201 patients had depression, of whom 182 had newly diagnosed prostate cancer and 100 were undergoing treatment with androgen deprivation therapy. Those receiving androgen deprivation therapy had higher rates of depression (P = .02).

Patients who had a lower educational status were more likely to have depression than those with a higher status. Additionally, patients with a lower performance status were more likely to experience depression, with 43% of patients reporting some loss of functional independence. Throughout the sample, 43% of patients reported to be sexually active, and those with depression reported significantly worse erectile dysfunction. Moreover, those with depression were more likely to have metastatic disease.

“Given the many adverse effects associated with depression, any prevalence rate of men with prostate cancer burdened by this psychological morbidity deserves consideration. This is consistent with recommendations to assess for depression among prostate cancer survivors. It is unclear as to how this rate of depression among men with prostate cancer might compare to men without malignant disease. We are not aware of any well-controlled studies with appropriate comparison subjects that provide data to answer this question,” the investigators concluded.

Reference

Fervaha G, Izard JP, Tripp DA, et al. Psychological morbidity associated with prostate cancer: rates and predictors of depression in the RADICAL PC study. Can Urol Assoc J. 2021;15(6):181-186. doi:10.5489/cuaj.6912