Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Eur J Cancer. 2013 May;49(7):1588-99. doi: 10.1016/j.ejca.2012.12.018. Epub 2013 Jan 19.
Risk of suicide is increased among men with prostate cancer. We investigated this association among men with low-risk cancer, usually detected by prostate specific antigen (PSA)-testing.
Relative risk (RR) of suicide was calculated by use of Poisson regression analysis within the Prostate Cancer data Base Sweden (PCBaSe) 2.0, a nation-wide, population-based database, comparing 105,736 men diagnosed with prostate cancer between 1997-2009 to 528,658 matched prostate cancer-free men.
During the first 6 months after diagnosis, there were 38 suicides among men with prostate cancer; incidence rate 0.73 per 1000 person-years (PY) and 30 suicides in the comparison cohort; 0.11 per 1000 PY, corresponding to a RR of suicide of 6.5 (95% confidence interval (CI) 4.0-10). Risk was highest among men with distant metastases, incidence rate 1.25 per 1000 PY, RR 10 (95% CI 5.1-21) but risk was also increased for men with low-risk tumours, incidence rate difference 0.45 per 1000 PY and RR 5.2 (95% CI 2.3-12) and across categories of socioeconomic status and comorbidity. Eighteen months after diagnosis, risk of suicide had decreased to 0.27 per 1000 PY, RR 1.0 (95% CI 0.68-1.5) for low-risk prostate cancer but remained increased among men with metastases, 0.57 per 1000 PY, RR 1.8 (95% CI 1.1-2.9).
Although the increase in absolute risk of suicide was modest, our findings reflect the severe psychological stress that prostate cancer patients may experience after diagnosis. The increased risk of suicide observed in men with prostate cancer, including low-risk, calls for increased awareness.
患有前列腺癌的男性自杀风险增加。我们研究了这种与通常通过前列腺特异性抗原（PSA）检测发现的低危癌症男性之间的关联。
利用全国性基于人群的前列腺癌数据库（PCBaSe）2.0 中的泊松回归分析，计算自杀的相对风险（RR）。将 1997-2009 年间诊断为前列腺癌的 105736 名男性与 528658 名匹配的无前列腺癌男性进行比较。
在诊断后的前 6 个月内，有 38 名前列腺癌患者自杀；发病率为每 1000 人年（PY）0.73 例，对照组为 30 例；每 1000 PY 0.11 例，RR 为 6.5（95%置信区间（CI）4.0-10）。在远处转移的男性中风险最高，发病率为每 1000 PY 1.25 例，RR 为 10（95%CI 5.1-21），但低危肿瘤男性的风险也增加，发病率差异为每 1000 PY 0.45 例，RR 为 5.2（95%CI 2.3-12），且跨越社会经济地位和合并症的类别。诊断后 18 个月，低危前列腺癌的自杀风险已降至每 1000 PY 0.27 例，RR 为 1.0（95%CI 0.68-1.5），而远处转移的男性风险仍较高，每 1000 PY 0.57 例，RR 为 1.8（95%CI 1.1-2.9）。
尽管自杀的绝对风险增加幅度不大，但我们的研究结果反映了前列腺癌患者在诊断后可能经历的严重心理压力。观察到患有前列腺癌（包括低危）的男性自杀风险增加，需要提高认识。
