Suicide and accidental deaths among men newly diagnosed with localized prostate cancer


A new article, just accepted for publication by BJU International, has again raised the question of risk for suicide among men diagnosed with prostate cancer.

There is no doubt at all that such a risk exists. However, it is a great deal more difficult to quantify that risk with accuracy — compared to either healthy men of similar ages or to men diagnosed with other forms of cancer.

Using information from the Surveillance, Epidemiology and End Results (SEER) database here in the USA, Dalela et al. report the results of an analysis of data from > 500,000 men diagnosed with localized prostate cancer (i.e., excluding men with evident metastatic disease) between 1988 and 2010 as compared to nearly 1 million men diagnosed with other forms of solid tumor during the same time period. Additional information is available in a commentary in Renal and Urology News.

Dalela et al. show that:

  • Over the course of the study’s 22-year time frame
    • 1,165/524,965 men diagnosed with localized prostate cancer (0.22 percent) committed suicide.
    • 2,232/956,576 men diagnosed with other solid tumors (0.23 percent) committed suicide.
    • 3,199/524,965 men diagnosed with localized prostate cancer (0.61 percent) died of accidental death.
    • 4,501/956,576 men diagnosed with other solid tumors (0.47 percent) died of accidental death.
  • Men diagnosed with localized prostate cancer
    • Were at increased risk of suicide and accidental deaths compared to men diagnosed with other solid tumors
      • Within the first year of diagnosis
      • When definitive treatment was recommended but not received
    • Were at lower overall risk of suicide and accidental deaths compared to men diagnosed with other solid tumors.

However, the authors are careful to note that the lack of any data documenting patients’ prior co-morbidities and drug addictions in the SEER data is a very important limitation to the results of their study.

We have previously commented on earlier studies by Fall et al. (in Swedish males) and by Fang et al. (looking at American males) that investigated the risk of suicide in men diagnosed with prostate cancer.

In trying to understand these data, it is worth noting that, according to data from the Centers for Disease Control, here in America, in 2011:

  • Suicide was the 10th most common cause of  death for people of all ages.
    • There were 39,581 suicides (an average of 108 each day).
    • Men were about 1.4 times more likely to commit suicide that women.
  • Accidental deaths and deaths from unintended injuries was the fifth most common cause of death for people of all ages.
    • There were 126,438 accidental deaths (an average of 346 each day)
    • Men were twice as likely as women to undergo accidental deaths.

5 Responses

  1. How does the 0.22/0.23% compare to the rate of suicide in the general male population … understanding there needs to be some type of age weighting to make the numbers comparable?

  2. Rick:

    It’s tiny … See the 2011 suicide and accidental death data given above in the commentary.

  3. Got it … I did some checking — the highest overall rate is in males 45-54 at approx 0.05% or a quarter of the rate encountered for men with cancer.

  4. Dear Rick:

    I don’t know where you got the number you refer to in your note above, but I just checked and the CDC data on suicides in men aged 40 to 80 years of age in 2013 show a total of 16,083 suicides among men in that age range during that year, i.e., 44 suicides every day. That seems to be far higher to me than the rate in prostate cancer patients (presumably almost all diagnosed between 40 and 80 years of age) suggested by the study data above.

    Mike

  5. Year as a Variable in Explaining the Suicide Rate

    Many of us have had relatives who died of prostate cancer in the 1980s or earlier, and memories of the experiences of those patients would have influenced the thinking of men in this study, which started in 1988, to an extent. Back in 1988, there would have been vivid memories of many prolonged and painful, uncomfortable deaths, with aggravating side effects; in fact, in the 1970s, one third of men diagnosed did not make it to the 5-year point.

    Over time that survival statistic has dramatically improved for prostate cancer, with 94% of all of us making it to the 15-year point and survival to the 5-year point at nearly 100%. Moreover, progress on many fronts has been impressive, including not only drugs, radiation, surgery, testing, imaging, general case management, and especially active surveillance, but also chemotherapy drugs and chemo side effect countermeasures. Awareness of such progress should be sinking in to the public’s conventional wisdom. That awareness should lead to greater optimism, and hence a reduction in suicides and heart attacks as reactions to the diagnosis. Sitemaster alluded to this in the review of the Fang study.

    I’m curious whether the study’s authors looked at rates of suicide and heart attack by year to see if there were trends.

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