Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes.
Amy N. Luckenbaugh, Christopher J.D. Wallis, Li‐Ching Huang, Daniela Wittmann, Zachary Klaassen, Zighuo Zhao, Tatsuki Koyama, Aaron A. Laviana, Ralph Conwill, Michael Goodman, Ann S. Hamilton, Xiao‐Cheng Wu, Lisa E. Paddock, Antoinette M. Stroup, Matthew R. Cooperberg, Mia Hashibe, O'Neil, Brock B, Sherrie H. Kaplan, Sheldon Greenfield, Karen E. Hoffman, David F. Penson, Daniel A. Barocas
Abstract
PurposeWe aimed to compare patient-reported mental health outcomes for men undergoing treatment for localized prostate cancer longitudinally over 5 years.Materials and methodsWe conducted a prospective population-based analysis using the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Patient-reported depressive symptoms (Centers for Epidemiologic Studies Depression [CES-D]) and domains of the Medical Outcomes Study 36-item Short Form survey evaluating emotional well-being and energy/fatigue were assessed through 5 years after treatment with surgery, radiotherapy (with or without androgen deprivation therapy) and active surveillance. Regression models were adjusted for outcome-specific baseline function, demographic and clinicopathological characteristics, and treatment approach.ResultsA total of 2,742 men (median [quartiles] age 64 [59-70]) met inclusion criteria. Baseline depressive symptoms, as measured by the CES-D, were low (median 4, quartiles 1-8) without differences between groups. We found no effect of treatment modality on depressive symptoms (p=0.78), though older age, poorer health, being unmarried and baseline CES-D score were associated with declines in mental health. There was no clinically meaningful association between treatment modality and scores for either emotional well-being (p=0.81) or energy/fatigue (p=0.054).ConclusionsThis prospective, population-based cohort study of men with localized prostate cancer showed no clinically important differences in mental health outcomes including depressive symptoms, emotional well-being, and energy/fatigue according to the treatment received (surgery, radiotherapy, or surveillance). However, we identified a number of characteristics associated with worse mental health outcomes including: older age, poorer health, being unmarried, and baseline CES-D score which may allow for early identification of patients most at risk of these outcomes following treatment.