Androgen Deprivation Therapy for Prostate Cancer May Increase Depression Risk

Androgen Deprivation Therapy for Prostate Cancer May Increase Depression Risk

Depression can be a common side effect of  androgen deprivation therapy (ADT) used to treat localized prostate cancer, according to a study, “Association of Androgen Deprivation Therapy With Depression in Localized Prostate Cancer,” published in the Journal of Clinical Oncology.

Locally advanced prostate cancer patients treated with androgen deprivation therapy (ADT), an antihormone therapy, and radiation therapy are known to have improved survival rates. But mounting evidence also shows that ADT use can have extensive adverse effects, including metabolic, cardiovascular, bone, and cognitive problems. ADT is also suspected of negatively impact mood, causing depression.

“We know that patients on hormone therapy often experience decreased sexual function, weight gain and have less energy — many factors that could lead to depression. After taking a deeper look, we discovered a significant association between men being treated with ADT for PCa [prostate cancer] and depression,” Paul Nguyen, MD, the study’s senior author and the director of Prostate Brachytherapy at Brigham and Women’s Hospital, said in a news release. “This is a completely under-recognized phenomenon. Around 50,000 men are treated with this therapy each year. It’s important not only for patients to know the potential side effects of the drugs they’re taking, but also for the physicians to be aware of this risk in order to recognize signs of depression in these patients and refer them for appropriate care.”

Researchers identified 78,552 men over age 65 treated for stage 2 to 3 prostate cancer from 1992 to 2006, using the SEER Medicare-linked database (excluding those with psychiatric diagnoses). The association between pharmacologic ADT and depression diagnosis or receipt of outpatient/inpatient psychiatric treatment was first assessed. Then the team examined the association between ADT treatment duration and each of the study’s endpoints.

Results revealed that 43 percent of patients treated with ADT, compared with those who were not, had a higher three-year cumulative depression incidence (7.1% versus 5.2%), and records of inpatient psychiatric treatment (2.8% versus 1.9%) and outpatient psychiatric treatment (3.4% versus 2.5%).

Findings also showed that the risk of depression increased with ADT duration, from 12% for less than six months of therapy, to 26% among those whose therapy lasted 7 to 11 months, and 37% among those treated for 12 months or longer.

“Patients and physicians must weigh the risks and benefits of ADT, and this additional risk of depression may make some men even more hesitant to use this treatment, especially in clinical scenarios where the benefits are less clear, such as intermediate-risk disease,” Dr. Nguyen said.

Researchers suggested that further studies investigate potential interventions that can reduce the risk for depression, and whether particular groups are at a higher risk, such as men with a clinical history of depression.