Scott E. Eggener, MD
Associate Professor of Surgery
Co-Director, Prostate Cancer Program
Director of Translational and Outcomes Research, Section of Urology
University of Chicago Medical Center, Chicago, IL;
Medical Research: What are the main findings of the study?
Answer: Depressed men with a diagnosis of intermediate- or high-risk prostate cancer have worse overall outcomes than those without baseline depression and are less likely to undergo definitive therapy. The difference in overall survival between men with and without a depression diagnosis was independent of prostate cancer treatment type.
Medical Research: Were any of the findings unexpected?
Answer: We were surprised to find that depressed men actually interacted more with health care providers than non-depressed men. The fact that their disease was more likely to be high-grade at diagnosis despite being non-palpable may potentially reflect biases regarding PSA screening by providers and/or patients.
Medical Research: What should clinicians and patients take away from your report?
Answer: Both clinicians and patients should recognize that there are likely social and biological factors that may contribute to the observed outcomes in this study. These may include provider biases about appropriate therapy for depressed men or patient treatment preference. It may be important to allow for interventions in the mental health management of a man newly diagnosed with prostate cancer prior to proceeding to treatment decision to allow for judicious and informed decision-making.
Medical Research: What recommendations do you have for future research as a result of this study?
Answer: Decreased survival in depressed men and women has been seen with multiple other medical conditions, including breast cancer, heart attack and stroke. A better understanding of the physiologic and social changes associated with depression may identify medical and behavioral interventions to improve outcomes in these patients.
Effect of Depression on Diagnosis, Treatment, and Mortality of Men With Clinically Localized Prostate Cancer
Sandip M. Prasad, Scott E. Eggener, Stuart R. Lipsitz, Michael R. Irwin, Patricia A. Ganz, and Jim C. Hu
JCO JCO.2013.51.1048; published online on July 7, 2014;