First-line treatment for prostate cancer and use of antidepressants

According to a recently reported study in the journal European Urology, men who received first-line surgery or radiation therapy for non-metastatic prostate cancer were significantly more likely to have taken an antidepressant 5 years later than comparable men who didn’t get such treatment.

This study by Matta et al. (available on line as a full text article, and see also this report on the Reuters web site) is based on a Canadian data set that included > 12,000 patients, inclusive of all men of 66 years and more, diagnosed in the Canadian province of Ontario between 2002 and 2009.

Here are the basic findings of the study:

  • Dara were available from a total of 12,082 men diagnosed with prostate cancer in three categories:
    • Those treated with immediate first-line surgery (n = 4,952)
    • Those treated with immediate irst-line radiation therapy (n = 4,994)
    • Those who were simply monitored on either active surveillance or watchful waiting for at least 12 months (n = 2,136)
  • Data were also available on an additional 57,127 matched males from the general population who were never diagnosed with prostate cancer.
  • Within the first year after treatment, 10.5 percent of all the prostate cancer patients were receiving antidepressant therapy.
  • In so-called “difference-to difference analysis”, adjusted for demographic and health characteristics, at up to 5 years post-treatment, and compared to the matched sets of men who were never diagnosed with prostate cancer
    • Men treated surgically for their prostate cancer were 49 percent more likely to have started antidepressant medication.
    • Men treated by radiation therapy for their prostate cancer were 33 percent more likely to have started antidepressant therapy.
    • Men diagnosed with prostate cancer but initially just monitored for at least a year had no increase in the use of antidepressant therapy.

We should note that it is not entirely clear from the paper what proportion of men in each of the data sets were taking antidepressants prior to any diagnosis with and treatment for their prostate cancer.

Arguably, this study tells us two things.

First, as clearly stated by the authors in their conclusion:

… men with nonmetastatic [prostate cancer] who initially receive surgery or radiotherapy, but not those who initially undergo surveillance, have an increased risk of antidepressant receipt after treatment.

But, in addition, it is also not unreasonable to hypothesize that, among men initially over-treated for relatively low-risk forms of prostate cancer that could be managed on active surveillance, avoidable depression is a direct consequence of such over-treatment.

Clearly we cannot actually conclude that the second hypothesis is accurate based on the data from this study, but it does appear, potentially, to be one more reason why active surveillance might be a better management option than immediate treatment for men with relatively low-risk forms of prostate cancer.

7 Responses

  1. In my opinion: Before testing and treatment men need to understand the following may or may not apply to them.

    Depression in prostate cancer patients is about 27% and 22% at 5 years, for advanced prostate cancer patients, depression is even higher.

    A published study found that prostatectomy-related regret increases over time: 47% of men at 5 years after surgery.

    Prostate cancer patients are at an increased risk for chronic fatigue, depression, suicide, and heart attacks.

    After a blind biopsy and conventional treatment men could be left impotent, incontinent, fatigued, exploited, embarrassed, isolated, devastated, demoralized, depressed, with ruined relationships, lost libido, possibly feminized-castrated or suicidal, sometimes financially ruined. And sometimes literally dead. Loss of libido has been estimated at about 45% or higher, excluding hormone therapy. Lower libido is almost never disclosed and sometimes it is completely denied as a side effect. After testing and treatment your life may be very different. Prostate cancer patients are sometimes elderly and exploited for profit. Aftercare for long-term side effects is sometimes ineffective, expensive, not offered, degrading, or nonexistent. Prostate cancer patients are seldom told about chronic fatigue, depression, loss of libido and the true risk of side effects are usually understated. Your dignity and privacy are sometimes disregarded. Modern medicine can fail, victimizes, or exploits prostate cancer patients.

  2. Editorial warning: It is unclear to us what some comments on this web site by some commentators are intended to convey to our readers.

    Any person who has surgery or radiation therapy or any other form of invasive treatment for almost any disorder is inevitably at risk for all sorts of complications and side effects of treatment. Some doctors are practicing medicine who shouldn’t be allowed to do so. Some patients fail to take the most basic steps to ensure that the doctor who is treating them is actually well qualified to do what he (or she) claims to be able to do. Some patients insist on having forms of invasive treatment for prostate cancer when their doctors clearly advise them that this is not a good idea. Also, the management of prostate cancer is extremely complicated and even the very best doctors can tell you stories of things that went unexpectedly wrong for no reason that anyone was ever able to identify.

    What JJ has failed to give any information about in his “opinions” stated above is that all the things that can go wrong when one decides to have treatment for one’s prostate cancer are linked to a series of definable and manageable risk factors. If you make sure that you get diagnosed and treated by an appropriately skilled physician who actually explains to you what he or she is suggesting you do and why, you can reduce the risk of a high proportion of these factors — but some of them can be neither eliminated nor reduced to minimally low levels.

    Also, since JJ fails to give any references for some of his more questionable claims, it is impossible to ensure their accuracy. It is certainly true, for example, that a significant number of men have been known in the past (and still are known today) to have later regret about their decision to have a radical prostatectomy. On the other hand, we have never previously heard the suggestion that as many as 47% of such men had such regret. Indeed it has always surprised us that the well-documented levels of regret, historically, have been much lower than that.

  3. In my opinion: My intent is not to imply all doctors are dishonest or to condemn all medical providers. The intent is to educate men of the consequences and dangers that may await them so they can take appropriate action and to inform patients of real world, typical, or worst case scenarios. Also to obtain the best testing and treatments available. I have also had excellent doctors and nurses, however this may not protect you or I from the incompetent ones. And I have had some incompetent doctors and nurses. Medical mistakes are the third most common cause of death in the USA. More then suicide, firearms. and motor vehicle accidents combined. Per Consumer Reports (May 2018 page 5), “Each year 8.8 million hospital patients suffer from preventable harm and 440,000 hospital patients die from medical errors and hospital-acquired infections.”

    I intentionally excluded most references because I did not want a debate to distract from the information provided. I understated my claims by adding the phrases: In my opinion, sometimes, could be, may or may not, etc. Anyone can Google and investigate for themselves.

  4. Dear JJ:

    Unfortunately, your intent (as stated here) and your prior message, would not be seen — by a lot of people — to come with the same actual intent. at all.

    We have no problem with your desire to let patients understand that the management of prostate cancer is fraught with risk (from poor medical care to the inherent difficulties associated with the treatment of prostate cancer). However, the ways that you express information about these risks do not (in our opinion) correlate with this desire. Rather, they come across as being statements with no attempt to impart any sense of balance about the risks and benefits of treatment, and this does not help men to make decisions. Rather, it is likely to frighten them into making poor decisions.

    You also need to appreciate that just because you can find a reference to some particular piece of information does not make that piece of information accurate. The medical and scientific literature is filled with studies that are of poor quality, do not represent what actually happens in the “real world”, or may have been true at a point in time but are no longer true at the current time.

    We respectfully suggest that you might want to think a little harder about how to communicate the cautions you are attempting to give to others.

  5. Wow. As a (n adult-) lifelong depressive, I have never dared tell my doctors that in my risk-return analysis I have to consider depression and the risk of ahem side effects (of depression, secondary to possible side effects of prostate cancer and/or treatment). But the absence of any increased uptake of antidepressants in the AS arm is a genuine surprise.

  6. We know that approximately 35% of prostate cancer patients suffer recurrence; and ADT is often prescribed on recurrence.

    An important factor may well be how many men were on hormone therapy, specifically ADT, at the time they were observed as taking an antidepressant.

  7. My takeaway is that each person needs to get up to speed on treatments for their specific cancer. Do your due diligence. You are the one that has to deal with the side effects.

    If I had to do it over I’d get an MRI-guided biopsy. I did have one after the initial “core” samples were taken.The collateral damage of the treatment is what I think would be depression causing and wondering if you made the right decision.

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