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Beyond the Abstract - Impact of androgen deprivation therapy on depressive symptoms in men with nonmetastatic prostate cancer, by Narhari Timilshina, MPH and Shabbir Alibhai, MD, MSc

BERKELEY, CA (UroToday.com) - We have recently published an article on the impact of androgen deprivation therapy on depressive symptoms in men with non-metastatic prostate cancer.1

In this article we explored the association between depression and use of Androgen deprivation therapy (ADT) on non-metastatic prostate cancer patients.

ADT is widely utilized for the treatment of Prostate Cancer (PC) patients; approximately 50% of prostate cancer patients will receive ADT at some point after diagnosis, typically for at least 2-3 years.2-4 A cancer diagnosis can mean a significant threat to patients and evoke strong psychological responses. In addition to developing prostate cancer, many of these men, by virtue of being middle-aged or elderly, are dealing with other issues such as retirement, loss of health due to comorbid illness, death of a spouse, etc.5 Given the vulnerability to depression of older patients with cancer who are on ADT, and the negative impact of depression on quality of life, medical adherence and morbidity, this relationship is important to clarify.

According to the American Cancer Society, up to 1 in 4 people with cancer develop clinical depression; which is higher than the general population (7%). Having prostate cancer, undergoing treatment, and coping with side effects such as reduced quality of life, urinary and sexual dysfunction, and other side effects,6-7 may increase the risk of depression.

Few studies have examined the impact of ADT on depression, however those existing studies including men with advanced disease, were comprised of small sample sizes, often lacked appropriate controls, and had varying periods of follow up (range 0 to 12 months), limiting the interpretation of findings. Thus, prior to our study, the impact of ADT on depression was unclear, particularly in men with non-metastatic disease.

Our study examined three separate cohorts, ADT users consisting of men with who were initiating continuous ADT for at least one year, men with prostate cancer who were not on ADT (PC controls), and healthy cohorts without prostate cancer. All three groups were matched on age, education and baseline physical function. Depression was measured with the 15-item Geriatric Depression Scale (GDS)8 at four time points, over 12 months.

Our study findings suggest that 12 months of ADT use is not significantly associated with worsening depressive symptoms among either non-depressed or depressed patients with non-metastatic prostate cancer. This finding should be reassuring to primary care physicians and prostate cancer clinicians who manage the adverse effects of ADT during the long-term follow-up of men with prostate cancer.

 

References:

  1. Impact of androgen deprivation Therapy on depressive symptoms in men with non-metastatic prostate cancer. Timilshina N, Breunis H, Alibhai S. Cancer. 2011 Aug 25; doi:10.1002/cncr.26477.[Epub ahead of print]
  2. Meng MV, Grossfeld GD, Sadetsky N, Mehta SS, Lubeck DP, Carroll PR. Contemporary patterns of androgen deprivation therapy use for newly diagnosed prostate cancer. Urology. Sep 2002;60(3 Suppl 1):7-11; discussion 11-12.
  3. Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA. Jul 13 2005;294(2):238-244.
  4. Shahinian VB, Kuo YF, Freeman JL, Orihuela E, Goodwin JS. Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate carcinoma. Cancer. Apr 15 2005;103(8):1615-1624.
  5. Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. Mar 2003;58 (3):249-265.
  6. Alibhai SMH, Breunis H, Timilshina N, et al. Impact of androgen-deprivation therapy on physical function and quality of life in men with non-metastatic prostate cancer. Journal of Clinical Oncology. 2010;28(34):5038-5045.
  7. Alibhai SM, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Critical Reviews in Oncology/Hematology. Dec 2006;60(3):201-215.
  8. Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research. 1982; 17(1):37-49.

 

Written by:
Narhari Timilshina, MPHa and Shabbir Alibhai, MD, MSca,b,c,d as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

  1. Department of Medicine, University Health Network
  2. Geriatric Program, Toronto Rehabilitation Institute
  3. Department of Medicine, University of Toronto
  4. Department of Health Policy, Management and Evaluation, University of Toronto

Corresponding author:

Shabbir M.H. Alibhai, University Health Network, Room EN14-214, 200 Elizabeth Street, Toronto. M5G 2C4

E-mail:

Telephone: (416) 340-5125

Fax: (416) 595-5826

 

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