Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer.

TitleEffect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer.
Publication TypeJournal Article
Year of Publication2014
AuthorsPrasad SM, Eggener SE, Lipsitz SR, Irwin MR, Ganz PA, Hu JC
JournalJ Clin Oncol
Date Published2014 Aug 10
KeywordsAged, Aged, 80 and over, Cohort Studies, Depression, Humans, Male, Prostatic Neoplasms, SEER Program, United States

PURPOSE: Although demographic, clinicopathologic, and socioeconomic differences may affect treatment and outcomes of prostate cancer, the effect of mental health disorders remains unclear. We assessed the effect of previously diagnosed depression on outcomes of men with newly diagnosed prostate cancer.

PATIENTS AND METHODS: We performed a population-based observational cohort study using Surveillance, Epidemiology, and End Results-Medicare linked data of 41,275 men diagnosed with clinically localized prostate cancer from 2004 to 2007. We identified 1,894 men with a depressive disorder in the 2 years before the prostate cancer diagnosis and determined its effect on treatment and survival.

RESULTS: Men with depressive disorder were older, white or Hispanic, unmarried, resided in nonmetropolitan areas and areas of lower median income, and had more comorbidities (P < .05 for all), but there was no variation in clinicopathologic characteristics. In adjusted analyses, men with depressive disorder were more likely to undergo expectant management for low-, intermediate-, and high-risk disease (P ≤ .05, respectively). Conversely, depressed men were less likely to undergo definitive therapy (surgery or radiation) across all risk strata (P < .01, respectively). Depressed men experienced worse overall mortality across risk strata (low: relative risk [RR], 1.86; 95% CI, 1.48 to 2.33; P < .001; intermediate: RR, 1.25; 95% CI, 1.06 to 1.49; P = .01; high: RR, 1.16; 95% CI, 1.03 to 1.32; P = .02).

CONCLUSION: Men with intermediate- or high-risk prostate cancer and a recent diagnosis of depression are less likely to undergo definitive treatment and experience worse overall survival. The effect of depression disorders on prostate cancer treatment and survivorship warrants further study, because both conditions are relatively common in men in the United States.

Alternate JournalJ. Clin. Oncol.
PubMed ID25002728
PubMed Central IDPMC4121505
Grant ListUL1 TR000430 / TR / NCATS NIH HHS / United States