Depression Associated With Less Definitive Therapy and Poorer Survival in Men With Clinically Localized Prostate Cancer


Key Points

  • Depression was associated with increased use of expectant management and androgen-deprivation therapy and decreased use of definitive therapy.
  • Depressed patients had significantly poorer overall survival.

In a population-based cohort study reported in the Journal of Clinical Oncology, Prasad et al found that men with depressive disorder prior to prostate cancer diagnosis were significantly less likely to undergo definitive therapy and had worse overall survival across all risk strata compared with their nondepressed counterparts.

Study Details

The study involved Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 41,275 men diagnosed with clinically localized prostate cancer between 2004 and 2007 and 1,894 men with a depressive disorder in the 2 years before prostate cancer diagnosis.

Men with depression were older (48% vs 44% ≥ 75 years) and had more comorbidities (Charlson score ≥ 2 in 24% vs 12%) and were more likely to be white (84% vs 80%), unmarried (33% vs 22%), and to reside in nonmetropolitan areas and areas of lower median income (all P < .05). Men with depression were also somewhat more likely to have poorly differentiated/undifferentiated disease (61% vs 59%, P = .03), but did not differ from nondepressed patients in clinical stage or Gleason score. Depressed patients had more physician visits in the 2 years prior to prostate cancer diagnosis (mean, 43 vs 27, P < .001).

Effects on Definitive Therapy and Survival

In adjusted analysis, patients with depression were significantly more likely to receive androgen-deprivation therapy alone (odds ratio [OR] = 1.23, P = .002), including those with intermediate-risk disease (OR = 1.24, P = .04), and to receive expectant management (OR = 1.29, P < .001), including those with low-risk (OR = 1.15, P = .005) and intermediate-risk disease (OR = 1.46, P < .001). Depressed patients with low-risk (OR = 0.76, P = .005) and high-risk disease (OR = 0.82, P = .03) disease were less likely to receive radiation therapy, and those with intermediate-risk disease were less likely to undergo surgery (OR = 0.72, P = .006). Overall, definitive therapy (surgery or radiation) was less likely to be selected by depressed patients with low-risk (OR = 0.71, P < .001), intermediate-risk (OR = 0.68, P < .001), and high-risk disease (OR = 0.77, P = .006).

Depressed men had significantly increased risk for overall mortality in low-risk (relative risk [RR] =1.86, P < .001), intermediate-risk (RR = 1.25, P < .01), and high-risk disease categories (RR = 1.16, P = .02).

The investigators concluded, “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.”

Jim C. Hu, MD, MPH, of University of California, Los Angeles, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by a Department of Defense Prostate Cancer Physician Training Award. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.