Hormonal treatment may trigger depression in men with prostate cancer
The study suggests that patients receiving androgen deprivation therapy should be monitored for post-surgical depression.
Increasingly doctors are becoming aware that for many men, a cancer diagnosis and treatment leads to depression, with suicide rates seen rising disproportionately for those with urological cancers. The group of researchers has shown that men who receive anti-hormonal treatment after a radical prostatectomy have an increased tendency to depression.
“The anti- hormonal treatment is given to control the growth of tumour cells. Unfortunately, we have found that it is also associated with depression,” said Anne Sofie Friberg, lead author of the study.
The researchers examined medical records of 5,570 men from the Danish Prostate Cancer Registry. They found that 773 of these men were treated for depression after surgery. They found that men treated with anti-hormonal medicines were 1.8 times more likely to suffer from depression than men who did not receive the additional treatment. The researchers also checked whether radiotherapy after radical prostatectomy was associated with depression, but these results were inconclusive.
“The treatment prevents the production of androgen hormones, like testosterone. We know from other studies that low testosterone can affect a man’s well-being, so it may be that limiting testosterone production might have the same effect, perhaps especially after a major stress such as cancer treatment. It is important to note that compared to men without prostate cancer the patients treated with prostatectomy as a whole has an increased risk of depression,” Friberg explained.
According to Friberg, after surgery, erectile dysfunction and urinary incontinence are frequent symptoms. In case of recurrence and hormonal treatment, these symptoms may worsen and in addition, altered body image and loss of libido are common. These treatment effects are likely to increase the risk of depression. Also, low testosterone levels may directly affect mood centres of the brain.
As many as 25% of men undergoing radical prostatectomy will relapse and may be offered hormonal treatment. These men appear to be at a higher risk of developing depression once hormonal treatment is introduced. The reason could be either a consequence of failing surgery, directly caused by the hormonal manipulation, or both.