Paul Nguyen

A new BWH study has found a significant association between depression and patients being treated for localized prostate cancer (PCa)—cancer that has not spread beyond the prostate—with androgen deprivation therapy (ADT). Through drugs or surgery, ADT reduces a patient’s level of androgen hormones to prevent prostate cancer cells from growing. These findings were published online in the Journal of Clinical Oncology earlier this month.

“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,” said senior author Paul Nguyen, MD, of Radiation Oncology. “After taking a deeper look, we have discovered a significant association between men being treated with ADT for PCa and depression.”

Nguyen calls this discovery “a completely under-recognized phenomenon.” Around 50,000 men are treated with ADT each year.

“It’s important not only for patients to know the potential side effects of the drugs they’re taking, but also for physicians to be aware of this risk so they can recognize signs of depression and refer these patients for appropriate care,” said Nguyen, who is the director of Prostate Brachytherapy at BWH. “Patients and physicians must weigh the risks and benefits of ADT, and the additional risk of depression may make some men hesitant to use this treatment, especially in clinical scenarios where the benefits are less clear.”

Researchers reviewed the data of 78,552 men over the age of 65 with stage I to III PCa; the data came from the SEER Medicare-linked database from 1992 to 2006. Researchers investigated the association between ADT and a diagnosis of depression or confirmation of inpatient or outpatient psychiatric treatment. Additionally, they looked at the association between the duration of ADT and depression.

When compared to patients who did not receive ADT, patients who received ADT had higher incidences of depression and inpatient and outpatient psychiatric treatment. Patients who received ADT had a 23-percent increased risk of depression, a 29-percent increased risk of inpatient psychiatric treatment and a non-significant 7-percent increased risk of outpatient psychiatric treatment when compared with patients not being treated with ADT. The risk of depression increased with the duration of ADT, from 12 percent with fewer than six months, to 26 percent from seven to 11 months of treatment, to 37 percent with patients being treated for 12 months or longer. A similar duration effect was seen for inpatient and outpatient psychiatric treatment.

Researchers encourage future studies to focus on interventions that could successfully reduce this risk and examine whether particular subpopulations are at a higher risk, such as patients with a history of depression.