Among men with early prostate cancer, the risk of depression is increased with the use of androgen-deprivation therapy (ADT), particularly among men who are treated with ADT for 12 months or longer.  It is important for patients receiving ADT to speak with their healthcare providers if they experience any feelings of depression, as effective treatment options to resolve depression are available. These results were recently published in the Journal of Clinical Oncology.

Prostate cancer is the most frequently diagnosed cancer in men aside from skin cancer. An estimated 220,800 new cases of prostate cancer are diagnosed annually in the U.S., with more than 27,500 men dying from the disease.

Prostate cancer is stimulated to grow from exposure to the male hormone, testosterone. Therefore, an important treatment component for prostate cancer includes agents that block the formation of testosterone. This type of treatment is referred to as androgen deprivation therapy (ADT). There are several different types of ADT agents that prevent formation of testosterone through different mechanisms.

Results from studies exploring a connection between ADT and depression have remained inconclusive, with some results demonstrating an increased risk of depression with ADT, while other results do not demonstrate any association between depression and ADT.

Researchers from the United States conducted a large clinical study in an attempt to clarify whether ADT might increase the risk of depression, in addition to a possible association between the length of treatment with ADT and depression among men with prostate cancer.

The study included over 78,550 men with early-stage prostate cancer who were older than 65 years of age. The patients were identified using the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute-Medicare-linked database from 1992 to 2006. Patients had not received a psychiatric diagnosis of depression or any psychiatric treatment within the year prior to their diagnosis of prostate cancer.

  • At 3 years following diagnosis, patients who received ADT had increased rates of depression and inpatient psychiatric treatment, compared to those who did not receive ADT.
  • Overall, patients treated with ADT experienced a 23% increased risk of depression, 29% increased risk of inpatient psychiatric treatment, and a 7% increased risk (which was not of significance) of outpatient psychiatric treatment, compared to those who were not treated with ADT.
  • The risk of depression increased with longer duration of use of ADT: patients who received 6 months or less of ADT had a 12% risk of depression, which increased to 26% among those who received 7-11 months of ADT, and to 37% among patients who received 12 or more months of ADT.

Based on these results, the researchers stated that “Pharmacologic ADT increased the risk of depression and inpatient psychiatric treatment in this large study of elderly men with localized [prostate cancer]. This risk increased with longer duration of ADT. The possible psychiatric effects of ADT should be recognized by physicians and discussed with patients before initiating treatment.”

Patients with localized prostate cancer being treated with ADT should speak with their healthcare provider should they experience symptoms of depression so that effective intervention can be established.

Reference: Dinh K, Reznor G, Muralidhar B, et al. Association of androgen deprivation therapy with depression in localized prostate cancer. Journal of Clinical Oncology. 2016; Published online before printApril 11, 2016, doi:10.1200/JCO.2015.64.1969.

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