In Prostate Cancer, Depression Means Less Treatment, Worse Outcomes

Jim Hu, MD

Study Author

Men diagnosed with prostate cancer after being diagnosed with depression were less likely to undergo definitive treatment for their cancer and had worse overall survival, investigators found in a study published in July in the Journal of Clinical Oncology. Prasad et al conducted the study because the effect of mental health disorders on prostate cancer treatment and outcomes was unclear, they wrote in their paper.

The observational study relied on data about patients from Surveillance, Epidemiology, and End Results-Medicare records. The authors considered data on 41,275 men diagnosed with clinically localized prostate cancer between 2004 and 2007, and from among them identified 1894 men found to have depressive disorder in the 2 years prior to their prostate cancer diagnoses.

The study’s endpoint was the effect of depression on prostate cancer treatment and outcome.

The investigators found that, compared to other men in the study population, those who had depressive disorder tended to be older, white or Hispanic, unmarried, living in nonmetropolitan areas that had a lower median income, and experiencing more comorbidities (P < .05). They found no clinicopathologic differences between the 2 cohorts of men, except that depressed men were more likely to have poorly differentiated tumors (P = .03).

Men with depression were more likely to have high-risk disease, but did not wait longer to begin their treatment of choice, the authors found.

In adjusted analyses, in comparison to other patients in the study, men with depressive disorder were more likely to undergo expectant management for prostate cancer of any risk level (P ≤.05) and less likely to undergo definitive therapy (surgery or radiation) across all risk strata (P <.01), the authors found. They also determined that depressed men experienced worse overall mortality across risk strata (low: relative risk [RR], 1.86; 95% CI, 1.48-2.33; P <.001; intermediate: RR, 1.25; 95% CI, 1.06- 1.49; P = .01; high: RR, 1.16; 95% CI, 1.03-1.32; P = .02).

The authors postulated some reasons for the connection between depression, treatment choice, and outcome.

It’s possible that provider bias about depression could lead to disparities in care—although, by putting the patient into more frequent contact with physicians, the condition might also result in better primary care and more appropriate therapy, the authors wrote. They cited the “loss of interest and lack of motivation” commonly associated with depression as a possible reason that this group of men chose less invasive treatment. Further, they stated that survival in this group could be affected by a “diminished capacity for appropriate self-care,” as well as small or less involved social networks, changes in sleep and physical activity patterns, and comorbidities specific to depression, such as altered endocrine regulation.

“The effect of depression disorders on prostate cancer treatment and survivorship warrants further study,” the authors wrote, “because both conditions are relatively common in men in the United States.”

Prasad SM, Eggener SE, Lipsitz SR, Irwin MR, Ganz PA, Hu JC. Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer. Published online July 7, 2014. J Clin Oncol. 2014;32.