School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada; Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
Department of Urology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada; Department of Oncology, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
Urol Oncol. 2019 Apr;37(4):282-288. doi: 10.1016/j.urolonc.2018.12.020. Epub 2019 Jan 7.
Prostate cancer is the most common malignancy among men. Given its prevalence and relatively low mortality rates, several biopsychosocial survivorship issues have garnered recent attention. This article reviews the literature on the association between depression and prostate cancer, emphasizing key practice points relevant for clinicians. Depression is prevalent among men with prostate cancer, with approximately 1 in 6 patients experiencing clinical depression. Suicidal ideation is also not uncommon in this population and does not always present in those with other depressive symptoms. While choice of definitive cancer treatment (radiation or surgery) does not seem to affect depressive symptoms, receipt of androgen deprivation therapy appears to have a negative effect. Not only are patients at increased risk for depression following a prostate cancer diagnosis, but depression itself seems to adversely affect oncologic outcomes. We were not able to identify any clinical trials examining the efficacy of antidepressant medications for depressive symptoms in these patients, however population-based studies suggest antidepressant prescriptions are commonly utilized. Taken together, the literature on the intersection between urologic oncology and psychology/psychiatry affirms the importance of depression among men with prostate cancer. Clinicians should consider assessment of this symptom domain and treat or refer judiciously. Clinical trials represent a priority for future research.
前列腺癌是男性中最常见的恶性肿瘤。鉴于其普遍性和相对较低的死亡率，一些生物心理社会生存问题最近引起了关注。本文综述了关于抑郁与前列腺癌之间关联的文献，强调了与临床医生相关的关键实践要点。患有前列腺癌的男性中抑郁较为普遍，约有 1/6 的患者出现临床抑郁。这一人群中自杀意念也并不罕见，且并不总是出现在有其他抑郁症状的患者中。虽然确定性癌症治疗（放疗或手术）的选择似乎不会影响抑郁症状，但雄激素剥夺疗法的应用似乎有负面影响。不仅是在前列腺癌诊断后，患者患抑郁症的风险增加，而且抑郁本身似乎对肿瘤学结果有不利影响。然而，我们没有发现任何临床试验来检验抗抑郁药物治疗这些患者抑郁症状的疗效，但是基于人群的研究表明，抗抑郁药物的处方通常被广泛使用。总之，泌尿科肿瘤学和心理学/精神病学交叉领域的文献证实了患有前列腺癌的男性中抑郁的重要性。临床医生应考虑评估这一症状领域，并进行合理的治疗或转介。临床试验代表了未来研究的重点。
