Mortality Risks Associated with Depression in Men with Prostate Cancer

Casey Crump; Pär Stattin; James D Brooks; Jan Sundquist; Weiva Sieh; Kristina Sundquist

doi:10.1016/j.euo.2024.03.012

Mortality Risks Associated with Depression in Men with Prostate Cancer

Eur Urol Oncol. 2024 Apr 3:S2588-9311(24)00089-0. doi: 10.1016/j.euo.2024.03.012. Online ahead of print.

Authors

Casey Crump¹, Pär Stattin², James D Brooks³, Jan Sundquist⁴, Weiva Sieh⁵, Kristina Sundquist⁴

Affiliations

¹ Department of Family and Community Medicine, The University of Texas Health Science Center, Houston, TX, USA; Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, USA. Electronic address: casey.crump@uth.tmc.edu.
² Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
³ Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
⁴ Center for Primary Health Care Research, Lund University, Malmö, Sweden.
⁵ Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.

PMID: 38575410
DOI: 10.1016/j.euo.2024.03.012

Abstract

Background: Men diagnosed with prostate cancer (PC) have an increased risk of depression; however, it is unclear to what extent depression affects long-term survival. A better understanding of such effects is needed to improve long-term care and outcomes for men with PC.

Objective: To determine the associations between major depression and mortality in a national cohort of men with PC.

Design, setting, and participants: A national cohort study was conducted of all 180 189 men diagnosed with PC in Sweden during 1998-2017. Subsequent diagnoses of major depression were ascertained from nationwide outpatient and inpatient records through 2018.

Outcome measurements and statistical analysis: Deaths were identified from nationwide records through 2018. Cox regression was used to compute hazard ratios (HRs) for all-cause mortality associated with major depression, adjusting for sociodemographic factors and comorbidities. Subanalyses assessed differences by PC treatment during 2005-2017. PC-specific mortality was examined using competing risks models.

Results and limitations: In 1.3 million person-years of follow-up, 16 134 (9%) men with PC were diagnosed with major depression and 65 643 (36%) men died. After adjusting for sociodemographic factors and comorbidities, major depression was associated with significantly higher all-cause mortality in men with high-risk PC (HR, 1.50; 95% confidence interval [CI], 1.44-1.55) or low- or intermediate-risk PC (1.64; 1.56-1.71). These risks were elevated regardless of PC treatment or age at PC diagnosis, except for youngest men (<55 yr) in whom the risks were nonsignificant. Major depression was also associated with increased PC-specific mortality in men with either high-risk PC (HR, 1.35; 95% CI, 1.28-1.43) or low- or intermediate-risk PC (1.42; 1.27-1.59). This study was limited to Sweden and will need replication in other countries when feasible.

Conclusions: In this national cohort of men with PC, major depression was associated with ∼50% higher all-cause mortality. Men with PC need timely detection and treatment of depression to support their long-term outcomes and survival.

Patient summary: In this report, we examined the effects of depression on survival in men with prostate cancer. We found that among all men with prostate cancer, those who developed depression had a 50% higher risk of dying than those without depression. Men with prostate cancer need close monitoring for the detection and treatment of depression to improve their long-term health outcomes.

Keywords: Cancer survivors; Depression; Major depressive disorder; Mortality; Premature mortality; Prostate cancer; Prostatic neoplasms.