Having hormone therapy to treat localized prostate cancer could place men at higher risk for developing depression.
This was the conclusion of a new study led by Brigham and Women's Hospital (BWH) in Boston, MA, and published in the Journal of Clinical Oncology that found a significant link between depression and men receiving androgen deprivation therapy (ADT) for localized prostate cancer.
Senior author Paul Nguyen, associate professor of radiation oncology at Harvard Medical School, explains that men on ADT for prostate cancer (PCa) often experience lower sexual function, put on weight and have less energy - all factors that can lead to depression. He adds:
"After taking a deeper look, we discovered a significant association between men being treated with ADT for PCa and depression. This is a completely under-recognized phenomenon."
The male sex hormone androgen - most of which is produced in the testicles - is required for the normal growth and function of the prostate, one of the glands that make semen. Prostate cancer cells also need androgen to grow. By binding to surface proteins on normal and cancerous prostate cells, the hormone influences the genes that cause prostate cells to grow.
In the early stages, some prostate cancers need lots of androgen to grow - these are called androgen-dependent or androgen-sensitive prostate cancers because treatments that reduce levels of the hormone or block its activity can stop the cancers growing.
ADT linked to 23% higher risk of depression
For their study, the researchers used data on 78,552 men over 65 years of age with stage 1 to 3 prostate cancer recorded in the SEER-Medicare Linked Database during 1992-2006.
- Around 50,000 American men with prostate cancer are treated with ADT every year
- Duration of treatment depends on a man's risk of recurrence
- Men with intermediate risk of recurrence usually receive ADT for 4-6 months, men with higher risk receive it for 2-3 years.
They looked for links between ADT and a diagnosis of depression or psychiatric treatment as an inpatient or outpatient. They also examined links between duration of treatment and depression.
The results showed that compared with patients who did not receive ADT, those who did were more likely to have depression or be receiving inpatient or outpatient psychiatric treatment.
Ruling out other factors, further analysis showed that compared with not receiving ADT, receiving ADT was linked to a 23% raised risk of depression, a 29% raised risk of inpatient psychiatric treatment, and a non-significant 7% higher risk of outpatient psychiatric treatment.
It also showed that risk of depression increased with duration of ADT: from 12% when treatment lasted under 6 months to 26% when it lasted 7-11 months and 37% when it lasted 12 months or longer. A similar duration effect was found for inpatient and outpatient psychiatric treatment.
The authors conclude that the "possible psychiatric effects of ADT should be recognized by physicians and discussed with patients before initiating treatment." Prof. Nguyen, who is also director of prostate brachytherapy at BWH, adds:
"Patients and physicians must weigh the risks and benefits of ADT, and this additional risk of depression may make some men even more hesitant to use this treatment, especially in clinical scenarios where the benefits are less clear, such as for intermediate-risk disease."
He says not only is it important that patients understand the potential side effects of the drugs they're taking, but that physicians are aware of this risk so they can spot signs of depression in their patients and refer them for appropriate care.
The researchers call for further studies to look at types of interventions that could reduce the risk of depression for men receiving ADT for prostate cancer, and also to identify which groups may be at higher risk - such as those with a history of depression.
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