Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes

Amy N Luckenbaugh¹, Christopher J D Wallis¹, Li-Ching Huang², Daniela Wittmann³, Zachary Klaassen^{4

5}, Zighuo Zhao², Tatsuki Koyama², Aaron A Laviana⁶, Ralph Conwill⁷, Michael Goodman⁸, Ann S Hamilton⁹, Xiao-Cheng Wu¹⁰, Lisa E Paddock¹¹, Antoinette Stroup¹¹, Matthew R Cooperberg¹², Mia Hashibe¹³, Brock B O'Neil¹⁴, Sherrie H Kaplan¹⁵, Sheldon Greenfield¹⁵, Karen E Hoffman¹⁶, David F Penson¹, Daniel A Barocas¹

Affiliations

¹ Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
³ Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan.
⁴ Division of Urology, Medical College of Georgia at Augusta University, Augusta, Georgia.
⁵ Georgia Cancer Center, Augusta, Georgia.
⁶ Department of Surgery and Perioperative Care, Dell Medical School, Austin, Texas.
⁷ Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
⁸ Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
⁹ Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California.
¹⁰ Department of Epidemiology, Louisiana State University Health Sciences Center New Orleans School of Public Health, New Orleans, Louisiana.
¹¹ Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, New Jersey.
¹² Department of Urology, University of California, San Francisco, California.
¹³ Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
¹⁴ Department of Urology, University of Utah Health, Salt Lake City, Utah.
¹⁵ Department of Medicine, University of California Irvine, Irvine, California.
¹⁶ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 34978488
PMCID: PMC9933911
DOI: 10.1097/JU.0000000000002370

Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes

Amy N Luckenbaugh et al. J Urol. 2022 May.

. 2022 May;207(5):1029-1037.

doi: 10.1097/JU.0000000000002370. Epub 2022 Mar 3.

Authors

Affiliations

¹ Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
² Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
³ Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan.
⁴ Division of Urology, Medical College of Georgia at Augusta University, Augusta, Georgia.
⁵ Georgia Cancer Center, Augusta, Georgia.
⁶ Department of Surgery and Perioperative Care, Dell Medical School, Austin, Texas.
⁷ Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
⁸ Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
⁹ Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California.
¹⁰ Department of Epidemiology, Louisiana State University Health Sciences Center New Orleans School of Public Health, New Orleans, Louisiana.
¹¹ Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, New Jersey.
¹² Department of Urology, University of California, San Francisco, California.
¹³ Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
¹⁴ Department of Urology, University of Utah Health, Salt Lake City, Utah.
¹⁵ Department of Medicine, University of California Irvine, Irvine, California.
¹⁶ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 34978488
PMCID: PMC9933911
DOI: 10.1097/JU.0000000000002370

Abstract

Purpose: We aimed to compare patient-reported mental health outcomes for men undergoing treatment for localized prostate cancer longitudinally over 5 years.

Materials and methods: We 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.

Results: A 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).

Conclusions: This 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.

Keywords: mental health; prostatic neoplasms; quality of life.

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Figures

**Figure 1:**
Diagram of the Assembly of the Comparative Effectiveness Analyses of Surgery and Radiation (CEASAR) Study Cohort and Final Analytic Cohort (CES-D10, Emotional Well-Being, Energy/Vitality cohort)

**Figure 2:**
Trend in unadjusted CES-D and SF-36 scores by treatment modality over time

See this image and copyright information in PMC

References

1. Hamdy FC, Donovan JL, Lane JA, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. The New England journal of medicine. 2016. - PubMed
1. Wallis CJ, Saskin R, Choo R, et al. Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis. European urology. 2015. - PubMed
1. Wallis CJD, Glaser A, Hu JC, et al. Survival and Complications Following Surgery and Radiation for Localized Prostate Cancer: An International Collaborative Review. European urology. 2018;73(1):11–20. - PubMed
1. Resnick MJ, Koyama T, Fan KH, et al. Long-term functional outcomes after treatment for localized prostate cancer. The New England journal of medicine. 2013;368(5):436–445. - PMC - PubMed
1. Barocas DA, Alvarez J, Resnick MJ, et al. Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years. JAMA : the journal of the American Medical Association. 2017;317(11):1126–1140. - PMC - PubMed

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Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes

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Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes

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