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Master of Public Health

Association Between Treatment for Localized Prostate Cancer and Mental Health Outcomes

AUTHORS

Luckenbaugh AN , Wallis CJD , Huang LC , Wittmann D , Klaassen Z , Zhao Z , Koyama T , Laviana AA , Conwill R , Goodman M , Hamilton AS , Wu XC , Paddock LE , Stroup A , Cooperberg MR , Hashibe M , O'Neil BB , Kaplan SH , Greenfield S , Hoffman KE , Penson DF , Barocas DA , . The Journal of urology. 2022 1 3; (). 101097JU0000000000002370

ABSTRACT

PURPOSE: We aim to compare patient-reported mental health outcomes for men undergoing treatment for localized prostate cancer, longitudinally over 5 years.

MATERIALS & METHODS: We conducted a prospective population-based analysis using the Comparative Effectiveness Analysis of Surgery and Radiation study (CEASAR) study. Patient-reported depressive symptoms (Centers for Epidemiologic Studies Depression, CES-D) and domains of the Medical Outcomes Study 36-item short form survey evaluating emotional well-being and energy/fatigue, were assessed through 5 years after treatment with surgery, radiotherapy (with or without androgen deprivation therapy) and active surveillance. Regression models were adjusted for outcome-specific baseline function, demographic and clinicopathologic characteristics, and treatment approach.

RESULTS: 2742 men (median [quartiles] age 64 [59-70]) met inclusion criteria. Baseline depressive symptoms, as measured by the CES-D, were low (median 4, quartiles 1-8) without differences between groups. We found no effect of treatment modality on depressive symptoms (p=0.78), though older age, poorer health, being unmarried, and baseline CES-D score were associated with declines in mental health. There was no clinically meaningful association between treatment modality and scores for either emotional well-being (p=0.81) or energy/fatigue (p=0.054).

CONCLUSIONS: This prospective, population-based cohort study of men with localized prostate cancer showed no clinically important differences in mental health outcomes including depressive symptoms, emotional well-being, and energy/fatigue according to the treatment received (surgery, radiotherapy, or surveillance). However, we identified a number of characteristics associated with worse mental health outcomes including: older age, poorer health, being unmarried, and baseline CES-D score which may allow for early identification of patients most at risk of these outcomes following treatment.

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