COMMENTARY

Beware Suicide Risk When Diagnosing Prostate Cancer

Gerald Chodak, MD

Disclosures

April 10, 2015

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Hello. I am Dr Gerald Chodak for Medscape. This week I want to talk about the possible increased risk of men with prostate cancer committing suicide. A study by Meyer and colleagues,[1] presented at the European Association of Urology annual meeting, raised that concern.

These investigators looked at the SEER (Surveillance, Epidemiology, and End Results) database and found that men diagnosed with prostate cancer, compared with other cancers, were at increased risk for suicide within the first 3 months and within the first year of the diagnosis. They also found that men who were unmarried, uninsured, or white had a higher risk than men who were married, insured, or black.

This study is slightly different from a previous SEER study[2] that looked at suicide rates over time among people diagnosed with various cancers. That study found that although rates of suicide were higher across the board, the rate of suicide among those with prostate cancer was actually lowest among the cancers affecting men. This study is finding a somewhat different result, although they did look at the result just primarily within the first year of diagnosis whereas the earlier study spanned 5 years of follow-up.

What Drives This Risk?

The question, of course, is why? Another study[3] looked at anxiety and depression in men diagnosed with prostate cancer and found that before diagnosis, there was a significant incidence of depression and anxiety which increased following the diagnosis, whether the men were treated or not. This also raises the question of whether treatment with active surveillance poses an added psychological risk for men who are diagnosed with the disease.

I believe that there are several things we cannot say yet. For example, does active surveillance significantly increase a man's risk when compared with any other treatment? It is difficult to understand why death from suicide would occur simply because of not receiving an active treatment. After all, men could simply decide within those first 3 months of diagnosis that they will go ahead and be treated. Thus, it is not clear that active surveillance is playing a role. However, we do know that there is an added psychological burden for men who choose active surveillance.

The real message is that doctors who diagnose prostate cancer need to be aware of this increased risk and should consider referring these men for counseling or at least consultation with a psychotherapist to search out whether anxiety and depression are present. This is similar to the need for consultations with proper physicians in other specialties when men who are treated with hormone therapy experience other side effects, aside from the cancer, that can affect their overall survival.

Again, we need to be aware of the psychological burden placed on anyone diagnosed with cancer. This is not restricted to men with prostate cancer. There may be an additional burden for people who do not have support systems or are worried about paying their bills. But dealing with active surveillance is something else that needs to be addressed in terms of the psychological effect it has on men.

I look forward to your comments. Thank you.

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