Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Eur Urol. 2023 Sep;84(3):263-272. doi: 10.1016/j.eururo.2023.04.026. Epub 2023 May 9.
A diagnosis of prostate cancer (PC) may cause psychosocial distress that worsens quality of life; however, long-term mental health outcomes are unclear.
To determine the long-term risks of major depression and death by suicide in a large population-based cohort.
DESIGN, SETTING, AND PARTICIPANTS: This was a national cohort study of 180 189 men diagnosed with PC during 1998-2017 and 1 801 890 age-matched, population-based, control men in Sweden.
Major depression and death by suicide were ascertained from nationwide outpatient, inpatient, and death records up to 2018. Cox regression was used to compute hazard ratios (HRs) adjusted for sociodemographic factors and comorbidities. Subanalyses assessed differences by PC treatment during 2005-2017.
Men diagnosed with high-risk PC had higher relative rates of major depression (adjusted HR [aHR] 1.82, 95% confidence interval [CI] 1.75-1.89) and death by suicide (aHR 2.43, 95% CI 2.01-2.95). These associations persisted for ≥10 yr after PC diagnosis. The relative increase in major depression was lower among those treated with radiation (aHR 1.44, 95% CI 1.31-1.57) or surgery (aHR 1.60, 95% CI 1.31-1.95) in comparison to androgen deprivation therapy (ADT) alone (aHR 2.02, 95% CI 1.89-2.16), whereas the relative rate of suicide death was higher only among those treated solely with ADT (aHR 2.83, 95% CI 1.80-4.43). By contrast, men with low- or intermediate-risk PC had a modestly higher relative rate of major depression (aHR 1.19, 95% CI 1.16-1.23) and higher relative rate of suicide death at 3-12 mo after PC diagnosis (aHR 1.88, 95% CI 1.11-3.18) but not across the entire follow-up period (aHR 1.02, 95% CI 0.84-1.25). This study was limited to Sweden and will need replication in other populations.
In this large cohort, high-risk PC was associated with substantially higher relative rates of major depression and death by suicide, which persisted for ≥10 yr after PC diagnosis. PC survivors need close follow-up for timely detection and treatment of psychosocial distress.
In a large Swedish population, men with aggressive prostate cancer had higher long-term relative rates of depression and suicide.
前列腺癌（PC）的诊断可能导致生活质量恶化的心理社会困扰；然而，长期的心理健康结果尚不清楚。
在大型基于人群的队列中确定患有 PC 的男性中重度抑郁症和自杀死亡的长期风险。
设计、设置和参与者：这是一项对 1998 年至 2017 年间诊断为 PC 的 180189 名男性和瑞典 1801890 名年龄匹配的基于人群的对照组男性的全国性队列研究。
通过全国范围内的门诊、住院和死亡记录，直到 2018 年，确定了重度抑郁症和自杀死亡。使用 Cox 回归计算调整了社会人口统计学因素和合并症后的危险比（HR）。亚分析评估了 2005-2017 年期间 PC 治疗差异的影响。
诊断为高危 PC 的男性出现重度抑郁症（调整后 HR[aHR]1.82，95%置信区间[CI]1.75-1.89）和自杀死亡（aHR 2.43，95%CI 2.01-2.95）的相对比率更高。这些关联在 PC 诊断后至少 10 年仍持续存在。与单独雄激素剥夺疗法（ADT）（aHR 2.02，95%CI 1.89-2.16）相比，接受放疗（aHR 1.44，95%CI 1.31-1.57）或手术（aHR 1.60，95%CI 1.31-1.95）治疗的男性，重度抑郁症的相对增加较低，而自杀死亡的相对比率仅在单独接受 ADT 治疗的男性中较高（aHR 2.83，95%CI 1.80-4.43）。相比之下，低危或中危 PC 的男性在 PC 诊断后 3-12 个月时出现重度抑郁症（aHR 1.19，95%CI 1.16-1.23）和自杀死亡的相对比率较高（aHR 1.88，95%CI 1.11-3.18），但在整个随访期间则没有（aHR 1.02，95%CI 0.84-1.25）。本研究仅限于瑞典，需要在其他人群中进行复制。
在这项大型队列研究中，高危 PC 与重度抑郁症和自杀的相对比率显著升高相关，这些关联在 PC 诊断后至少 10 年仍持续存在。PC 幸存者需要密切随访，以便及时发现和治疗心理社会困扰。
在瑞典的一项大型人群研究中，患有侵袭性前列腺癌的男性长期患有抑郁症和自杀的相对比率较高。
