There is a lot you can learn from the massive datasets acquired in the countries that keep national health registries. The National Prostate Cancer Registry of Sweden, for example, has data on almost 200,000 men diagnosed with prostate cancer between 1998 and 2017. With samples that size, one can look at slew of factors that can influence serious, but rare outcomes of a cancer diagnosis and its treatment. A good example is the risk of depression and suicide for men with prostate cancer. And we now have a registry study from Sweden that looked at exactly that.
The authors of this new study found that men diagnosed with high-risk PCa have substantially higher rates of major depression and suicide relative to men without PCa. These risks remain high >10 years post diagnosis. In contrast, men with low or intermediate risk PCa have modestly higher rates of major depression and slightly elevated risk of suicide, but this is only seen in the first year after their diagnosis.
Other factors that came into play in terms of an elevated risk of depression are having lower education, lower income, and also having had a previous history of depression before the prostate cancer diagnosis.
What also stands out for us, and it is relevant to readers of this blog now, is ADT was a contributory factor for depression in the advanced patients.
One of the strengths of this study was that the researchers could compare all the prostate cancer patients to other men in the health registry that were matched with the cancer patients in terms of the age and any comorbidities that they had.
A diagnosis of prostate cancer itself can raise the risk of depression. But when the cancer is of low risk and patients realize that they can have many years of life, the risk of depression declines within a year or so. Patients, however, who are diagnosed with more advanced disease are in a different and more challenging situation; they are more likely to go on ADT and if the disease progresses, the risk of depression goes up. Here both treatment with ADT and disease progression, or the fear of it, exacerbate pre-existing depression.
What we believe the major take home message from this study is not that ADT causes men to become suicidal, for the number was extremely low in this population; i.e, just one in 500 of the advanced patients. However, the incidents of major depression were about 8% of the men in this study. That led the authors to push for men diagnosed with prostate cancer to be screened for depression. Our take on that is that it's important that patients, who have had episodes of major depression and are starting an ADT, to be aware of the risk and to inform their clinicians of their history. We agree with the authors as well, that along with monitoring the status of the patients’ cancer, their mental health should also be assessed, particularly if they go on ADT.
Reference:
Crump, C., Stattin, P., Brooks, J. D., Sundquist, J., Bill-Axelson, A., Edwards, A. C., Sundquist, K., & Sieh, W. (2023). Long-term Risks of Depression and Suicide Among Men with Prostate Cancer: A National Cohort Study. European urology, S0302-2838(23)02787-2. Advance online publication. https://doi.org/10.1016/j.eururo.2023.04.026