Locally advanced or metastatic prostate cancer increases risk for suicide
MedWire News: Men diagnosed with locally advanced or metastatic prostate cancer are twice as likely to commit suicide as men in the general population, according to a Swedish study.
However, no increase in suicide rates was observed among prostate cancer patients diagnosed following prostate-specific antigen (PSA) testing.
“We found no evidence for an increased risk for suicide among men diagnosed with early nonpalpable prostate cancer detected by PSA testing,” report Anna Bill-Axelson, from University Hospital in Uppsala, and colleagues.
The researchers used the Prostate Cancer Base Sweden database (incorporating the National Prostate Cancer Register), the Swedish Cause of Death Register, and the Swedish census database to compare the expected number of suicides between 1997 and 2006 in the general male population with the number in men diagnosed with prostate cancer.
They correlated this information with patients’ clinical and other features including T-stage and mode of detection (ie, symptoms, screening, other).
Of 77,439 men aged 30–85 years who were diagnosed with prostate cancer in the study period, 128 committed suicide, generating a rate of 48.3 suicides per 100,000 person-years. The corresponding rate of suicides in the general male population was 31.9 per 100,000 person-years.
The expected number of suicides in the prostate cancer patient cohort during the study period was 84.6, corresponding to a 1.5-fold increased risk among these men.
Suicide risk increased significantly during the first and second years after diagnosis, with no difference according to age. Men who had their PSA levels tested as a result of the emergence of symptoms had a two-fold increase in suicide risk compared with men whose tumors were detected during screening.
Contrary to the researchers’ hypothesis, men with nonpalpable, PSA-detected stage T1c or T2 tumors had no increased risk for suicide compared with the general male population. However, in patients whose cancer was stage T3 or T4, the risk was 2.2-fold.
A two-fold risk increase was also seen in men whose cancer had metastasized.
“Anxiety related to a crisis reaction may develop into a depression, and several studies have shown that there is a high anxiety level among screeners in various screening programs,” explain the researchers in the journal European Oncology.
They conclude that the increased risk for suicide among men with advanced and metastatic prostate cancer is important “in order to focus on the need to identify signs of depression and optimize treatment among this category of patients.”
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By Sarah Guy