One of the largest randomized-controlled trials to date shows a high prevalence of anxiety and depression in patients with localized prostate cancer, further highlighting the mental/emotional burden associated with the disease, according to a study presented at the 2022 American Urological Association Annual Meeting.
According to Sumedha Chhatre, MD, of the Perelman School of Medicine, who presented the research findings, despite the widely acknowledged effects prostate cancer has on mood and mental health, these effects have remained understudied and likewise under-quantified. To overcome this research gap, Dr. Chhatre and colleagues evaluated both the short- and long-term burden of anxiety and depression by treatment type across various prostate cancer risk factors.
The study relied on data from a multi-centered randomized controlled study which included 743 patients with localized prostate cancer. The researchers evaluated anxiety and depression outcomes at the study’s baseline, and then again at 3, 6, 12, and 24 months of follow-up.
Patients received either active surveillance, robotic-assisted laparoscopic radical prostatectomy, and/or radiation therapy. Approximately 34% of patients were categorized into the low-risk group (prostate-specific antigen [PSA] <10 ng/ml, Gleason ≤ 6, clinical stage T1-2a), 32% were categorized as intermediate-risk (PSA 10 -20 ng/ml, Gleason 7, clinical stage T2b), and 34% were categorized as high-risk (PSA > 20, Gleason ≥8, clinical stage T2c-3a).
The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess depression in this cohort, while the Scale for Prostate Cancer (MAX-PC) was used to assess anxiety (MAX-PC score >27 indicated anxiety). The investigators compared the proportions of participants with anxiety and depression by treatment type and for each prostate cancer risk category.
During follow-up, the study retention rate was >75% during follow-up. The proportions of patients with depression among all risk groups and for all treatment types significantly increased during the follow-up period.
In the low-risk group, the proportion of patients on active surveillance who met criteria for depression was lower than that of the surgery and radiation groups at 24 months (25% vs. 46% and 43%, respectively). At 24 months, the proportion of patients with depression was similar between surgery and radiation groups for the intermediate- and high-risk groups. The researchers reported that they observed a similar pattern for burden of anxiety.
Dr. Chhatre and colleagues noted that future research is needed to evaluate the effects of anxiety and depression on processes of care and clinical outcomes. The researchers added that “patient-centered survivorship care strategies are needed for reducing depression and anxiety and improving outcomes in prostate cancer care.”