Impact of androgen deprivation therapy on depressive symptoms in men with nonmetastatic prostate cancer

Authors N Timilshina, H Breunis, S Alibhai

Review Date Nov 2011

Citation Cancer 2011: 10.1002/cncr.26477 [Epub ahead of print]

Background

Up to 50% of prostate cancer (PC) patients receive androgen deprivation therapy (ADT), often for several years. Although depression has been reported after a diagnosis of PC, and men on ADT describe emotional lability and depressed mood, it is not clear whether ADT actually leads to or worsens depression.

The few other studies addressing this question often included only men with advanced disease and had various methodological problems, thereby limiting the interpretation of findings.

Aim

To assess depressive symptoms and incident depression (Geriatric Depression Scale (GDS) score >=5) in a prospective matched cohort study of men with non-metastatic prostate cancer and two control groups.

Methods

Three groups were assembled: ADT users (men initiating continuous ADT), PC controls (PC patients who were not on ADT), and healthy controls. All three cohorts were matched on age, education, and physical function, and none had metastases.

Depression was measured at study entry and again at 3, 6, and 12 months using the 15-item Geriatric Depression Scale (GDS). The GDS has been validated in middle-aged and older adults.

The primary outcomes were worsening depressive symptoms and incident depression (defined as a GDS score ≥5), analyzed using adjusted linear regression and logistic regression, respectively.

Results

Of the 257 participants (mean age 69.1 years; range 60-80 years), baseline characteristics including GDS score and prior depression were similar across cohorts.

In adjusted analyses of initially non-depressed patients, ADT use was not a significant predictor of change in GDS score at 3 months (P = 0.42), 6 months (P =0.25), or 12 months (P = 0.19). Among ADT users, 8%-9% of participants developed incident depression compared with 0%-4% among PC controls and 4%-6% among healthy controls over 3-12 months (P>0.05 at all time points).

In a separate analysis of patients with depression at baseline, there was no effect of ADT on depressive symptoms at 3, 6, or 12 months (P = 0.11, 0.74, and 0.12, respectively).

Conclusion

Using ADT for up to 12 months was not associated with worsening depressive symptoms among non-depressed or depressed patients with non-metastatic PC.

Points to Note

1. This controlled prospective study suggests that ADT per se is not associated with incident depressive symptoms in older men with non-metastatic PC.
2. It appears that it is more likely that a prostate cancer diagnosis is associated with developing depressive symptoms rather than ADT.
3. Limitations of the study include: few men with prevalent depression were included; men with severe depression were excluded; the GDS measures depressive symptoms rather than clinical depression; overall sample size was relatively small.
4. The results that show a lack of effect of ADT on worsening of depressive symptoms in men with prevalent depressive symptoms were based on very small numbers of men and should be interpreted with caution.
5. ADT use is associated with a variety of adverse effects but this study would suggest that depression is not one of them, providing information useful for counselling men before initiation of ADT.
6. Depression in men with PC should be assessed and managed whether men are ADT users or not. 

Website: www.ncbi.nlm.nih.gov/pubmed/22009684