There is new research out of Germany exploring factors associated with psychological distress amongst men with prostate cancer. The study involved mail-in questionnaires that were completed by men who had been diagnosed with a genital cancer. The study wasn't specific to men on ADT, but included 636 prostate cancer patients, of whom 112 were on some form of “hormone therapy.” So what did the researchers find?
For the total sample of prostate cancer patients, the prevalence of clinically significant depressive symptoms was 23%, and the prevalence of clinically significant symptoms of anxiety was 22%. These numbers are relatively high compared to previously published data and suggest some sampling bias. By that we mean that distressed patients may have been more likely than non-distressed patients to fill in the questionnaires and mail them back.
The researchers also found that “ADT-related sexual problems were significantly associated with depression and anxiety” and “younger age was associated with a higher risk for both depression and anxiety”. No surprises there.
What is somewhat surprising to us, and to the researchers themselves, is that they did not find a strong association of “hormone therapy” with depression. This may reflect the general high level of depression in their total patient population. But the authors pointed out another problem in that “hormone therapy” was not defined in their questionnaire and appears to have included drugs like the 5 alpha-reductase inhibitor Finasteride (Proscar). Finasteride can cause depression, but not to the same extend as has been commonly reported for the primary ADT agents, such as the LHRH agonists.
Furthermore, the sample size was not large, calling into question the statistical significance of the results. Two take–home messages stand out. First, in general, voluntary surveys of distress for most any population are prone to sampling bias. Secondly, research projects assessing the impact of “hormone therapy” need to be careful about what drug and treatments are included under that label.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/32658367/
Esser P, Mehnert-Theuerkauf A, Friedrich M, et al. Risk and associated factors of depression and anxiety in men with prostate cancer: Results from a German multicenter study [published online ahead of print, 2020 Jul 13]. Psychooncology.