MP28-08: Burden of depression and anxiety in men with high-risk, intermediate-risk or low-risk prostate cancer

Sumedha Chhatre*, S Bruce Malkowicz, Ravishankar Jayadevappa, Philadelphia, PA

Introduction: While psychological difficulties such as depression and anxiety facing men with prostate cancer are acknowledged widely, they remain understudied. Objective was to assess the short-term and log-term burden of depression and anxiety by treatment type across different risk categories of prostate cancer.

Methods: We used data from a multi-centered randomized controlled study among localized prostate cancer patients.  Outcomes were assessed at baseline, and at 3, 6, 12 and 24-month follow-up. Treatments were robotic-assisted laparoscopic radical prostatectomy, radiation therapy and active surveillance. Participants were categorized into risk groups as: low risk (PSA <10 ng/ml, Gleason = 6, clinical stage T1-2a), intermediate risk (PSA 10 -20 ng/ml, Gleason 7, clinical stage T2b), and high risk (PSA > 20, Gleason =8, clinical stage T2c-3a). Depression was assessed using Center for Epidemiologic Studies Depression (CES-D) scale. CES-D score > 16 indicates depression. Anxiety was assessed using Scale for Prostate Cancer (MAX-PC). MAX-PC score > 27 indicates anxiety. Proportion of participants with depression and anxiety were compared by treatment type, for each prostate cancer risk category.

Results: Total of 743 localized prostate cancer patients were recruited for the study.  Retention rate was > 75% during follow-up. 34% patients were low-risk, 32% were intermediate-risk and 34% were high-risk. For all risk groups, proportion of patients with depression increased between baseline and 24-month, for all treatment types. For low-risk group, at 24-month, proportion of patients on active surveillance who were depressed was lower than surgery and radiation groups (25% vs. 46% and 43%). For intermediate-risk and high risk-group, at 24-month, proportion of patients with depression was comparable between surgery and radiation.  Similar pattern was observed for burden of anxiety.

Conclusions: Ours is one of the largest randomized controlled study that has assessed the burden of depression and anxiety in localized prostate cancer patients. In our study, we observed that a substantial proportion of localized prostate cancer patients experienced depression and anxiety. Especially, in the follow-up period, the proportion of patients with depression and anxiety increased significantly. Future studies need to examine the effects of depression and anxiety on process of care and outcomes; and the pathways. Patient-centered survivorship care strategies are needed for reducing depression and anxiety and improving outcomes in prostate cancer care.

Source of Funding: Patient-centered Outcomes Research Institute (PCORI) CE-12-11-4973