The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Urology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.
Prostate Cancer Prostatic Dis. 2018 Nov;21(4):499-508. doi: 10.1038/s41391-018-0073-6. Epub 2018 Aug 14.
Whether the diagnosis of prostate cancer is a contributory psychological stress that causes excess risk of suicide among affected men remains controversial. We performed a meta-analysis of previous studies to investigate suicide incidence and associated risk factors among men diagnosed with prostate cancer.
The MEDLINE, Embase, Cochrane Library, and PsycINFO databases were searched to identify eligible studies published before April 2018. The inverse variance method with random-effects modeling was used to calculate summary relative risks (RRs) and their associated 95% confidence intervals (CIs).
Eight observational studies involving 1,281,393 men diagnosed with prostate cancer and 842,294 matched prostate cancer-free men were included. An overall increased RR of suicide of 2.01 (95% CI: 1.52-2.64; P < 0.001; I = 91.8%) was observed among men diagnosed with prostate cancer compared with those without prostate cancer during the first year, especially during the first 6 months (RR = 2.24, 95% CI: 1.77-2.85; P < 0.001; I = 61.1%) after diagnosis. Moreover, prostate cancer patients were at an increased risk of suicide among men aged 75 years or older (RR = 1.51, 95% CI: 1.04-2.18; P = 0.028; I = 91.5%) and treated with hormonal therapy (RR = 1.80, 95% CI: 1.54-2.12; P < 0.001; I = 0%). Furthermore, marital status, race, disease risk category, and socioeconomic status were not associated with increased suicide risk in men with prostate cancer.
Current evidence indicates that the risk of suicide is increased among men diagnosed with prostate cancer, particularly those aged 75 years or older, <12 months after diagnosis, and treated with hormonal therapy. Healthcare providers should be aware of these special populations considered at high risk of suicide. Hence, further research should be conducted to refine suicide risk assessment with detection tools and to develop the best practices for prevention.
前列腺癌的诊断是否是导致患病男性自杀风险增加的一个促成性心理压力因素，目前仍存在争议。我们对以往研究进行了荟萃分析，以调查诊断为前列腺癌的男性的自杀发生率和相关风险因素。
我们检索了 MEDLINE、Embase、Cochrane 图书馆和 PsycINFO 数据库，以确定截至 2018 年 4 月前发表的合格研究。采用随机效应模型的Inverse variance 方法计算汇总相对风险（RR）及其相关的 95%置信区间（CI）。
纳入了 8 项观察性研究，涉及 1281393 名被诊断患有前列腺癌和 842294 名匹配的无前列腺癌男性。与无前列腺癌的男性相比，被诊断患有前列腺癌的男性在第一年，尤其是在诊断后前 6 个月（RR=2.24，95%CI：1.77-2.85；P<0.001；I=61.1%）自杀风险总体增加 2.01（95%CI：1.52-2.64；P<0.001；I=91.8%）。此外，在年龄≥75 岁（RR=1.51，95%CI：1.04-2.18；P=0.028；I=91.5%）和接受激素治疗（RR=1.80，95%CI：1.54-2.12；P<0.001；I=0%）的前列腺癌患者中，自杀风险增加。此外，婚姻状况、种族、疾病风险类别和社会经济地位与前列腺癌男性自杀风险增加无关。
目前的证据表明，诊断为前列腺癌的男性自杀风险增加，尤其是年龄≥75 岁、诊断后<12 个月、接受激素治疗的男性。医疗保健提供者应意识到这些被认为自杀风险较高的特殊人群。因此，应进一步开展研究，利用检测工具来完善自杀风险评估，并制定最佳预防实践。
