Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies



Psychiatric implications of prostate cancer are increasingly recognised, having important effects on oncological and functional outcomes. However, findings for co-occurring depression, anxiety, and suicidality remain variable. Therefore, this review of observational studies aimed to establish best estimates of the prevalence and rates of these outcomes in prostate cancer patients.


A systematic literature search was conducted using MEDLINE, Scopus, PsycInfo, and Cochrane Library databases from inception up to 26 May 2020. Observational studies using validated methods for evaluating prevalences of depression, anxiety and suicidal ideation, or suicide mortality rates post prostate cancer diagnosis were included. Random effect models were used to calculate pooled prevalences of depressive and anxiety symptoms or disorders, and suicidal ideation post diagnosis. Additionally, pooled crude suicide mortality rates per 100,000 person years were calculated. Heterogeneity was explored using a stratified analysis.


Of 3537 articles screened, 117 were included. Pooled prevalence for depressive disorders was 5.81% (95% CI 4.36–7.46) in 11 studies, representing 655,149 patients. Significant depressive symptoms were identified in 17.07% (15.14–19.09) across 32,339 patients and 76 studies. In total, 16.86% (14.92–18.89) had significant anxiety symptoms in 56 studies combining 24,526 patients. In 6,173 patients and eight studies, recent suicidal ideation was present in 9.85% (7.31–12.70). Crude suicide mortality rate after diagnosis was 47.1 (39.85–54.96) per 100,000 person years in 12 studies. Significant heterogeneity was seen with potential sources identified through our sensitivity analysis including diagnostic method utilised, study size and location of study.


The mental health impact in patients with prostate cancer is significant. Depressive, anxiety, and suicidal symptoms were common. Additionally, a high suicide mortality rate was identified when compared to general population estimates. Screening of patients and integration of physical and mental health care should be evaluated further to improve quality of life and functional outcomes.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Study selection.
Fig. 2: Pooled prevalence of depressive disorders in prostate cancer.
Fig. 3: Pooled prevalence of significant depressive symptoms in prostate cancer.
Fig. 4: Pooled prevalence of significant anxiety symptoms in prostate cancer.


  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  Google Scholar 

  2. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncol. 2014;15:23–34.

    Article  Google Scholar 

  3. Bourke L, Boorjian SA, Briganti A, Klotz L, Mucci L, Resnick MJ, et al. Survivorship and improving quality of life in men with prostate cancer. Eur Urol. 2015;68:374–83.

    Article  Google Scholar 

  4. Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415.

    Article  Google Scholar 

  5. Fervaha G, Izard JP, Tripp DA, Rajan S, Leong DP, Siemens DR. Depression and prostate cancer: a focused review for the clinician. Urol Oncol. 2019;37:282–8.

    Article  Google Scholar 

  6. Nead KT, Sinha S, Yang DD, Nguyen PL. Association of androgen deprivation therapy and depression in the treatment of prostate cancer: a systematic review and meta-analysis. Urol Oncol. 2017;35:664.e1–9.

    CAS  Article  Google Scholar 

  7. Dickey SL, Grayson CJ. The quality of life among men receiving active surveillance for prostate cancer: an integrative review. Healthcare. 2019;7:14.

  8. Dall’Era MA. Patient and disease factors affecting the choice and adherence to active surveillance. Curr Opin Urol. 2015;25:272–6.

    Article  Google Scholar 

  9. Sciarra A, Gentilucci A, Salciccia S, Von Heland M, Ricciuti GP, Marzio V, et al. Psychological and functional effect of different primary treatments for prostate cancer: a comparative prospective analysis. Urol Oncol. 2018;36:340.e7–21.

    Article  Google Scholar 

  10. Prasad SM, Eggener SE, Lipsitz SR, Irwin MR, Ganz PA, Hu JC. Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer. J Clin Oncol. 2014;32:2471–8.

    Article  Google Scholar 

  11. Kolva E, Hoffecker L, Cox-Martin E. Suicidal ideation in patients with cancer: a systematic review of prevalence, risk factors, intervention and assessment. Palliat Support Care. 2020;18:206–19.

    Article  Google Scholar 

  12. Amiri S, Behnezhad S. Cancer diagnosis and suicide mortality: a systematic review and meta-analysis. Arch Suicide Res. 2020;24:S94–S112.

    Article  Google Scholar 

  13. Klaassen Z, Wallis CJD, Chandrasekar T, Goldberg H, Sayyid RK, Williams SB, et al. Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: a matched-cohort study of patients with incident solid-organ malignancies. Cancer. 2019;125:2886–95.

    CAS  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    Article  Google Scholar 

  15. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    CAS  Article  Google Scholar 

  16. Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72:39.

    Article  Google Scholar 

  17. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.

    Article  Google Scholar 

  18. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65:934–9.

    Article  Google Scholar 

  19. World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.

  20. Walker J, Holm Hansen C, Martin P, Sawhney A, Thekkumpurath P, Beale C, et al. Prevalence of depression in adults with cancer: a systematic review. Ann Oncol. 2013;24:895–900.

    CAS  Article  Google Scholar 

  21. Krebber AMH, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23:121–30.

    CAS  Article  Google Scholar 

  22. Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol. 2013;14:721–32.

    Article  Google Scholar 

  23. Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, et al. Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. J Clin Psychiatry. 2010;71:1617–28.

    Article  Google Scholar 

  24. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26:4731–8.

    Article  Google Scholar 

  25. Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4:e003901.

    Article  Google Scholar 

  26. Guo Z, Gan S, Li Y, Gu C, Xiang S, Zhou J, et al. Incidence and risk factors of suicide after a prostate cancer diagnosis: a meta-analysis of observational studies. Prostate Cancer Prostatic Dis. 2018;21:499–508.

    Article  Google Scholar 

  27. Kinsella N, Stattin P, Cahill D, Brown C, Bill-Axelson A, Bratt O, et al. Factors influencing men’s choice of and adherence to active surveillance for low-risk prostate cancer: a mixed-method systematic review. Eur Urol. 2018;74:261–80.

    Article  Google Scholar 

  28. Nguyen TQ, Simpson PM, Braaf SC, Cameron PA, Judson R, Gabbe BJ. Level of agreement between medical record and ICD-10-AM coding of mental health, alcohol and drug conditions in trauma patients. Health Inf Manag. 2019;48:127–34.

  29. Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, Ho RC. Prevalence of depression in the community from 30 countries between 1994 and 2014. Sci Rep. 2018;8:2861.

  30. Levis B, Yan XW, He C, Sun Y, Benedetti A, Thombs BD. Comparison of depression prevalence estimates in meta-analyses based on screening tools and rating scales versus diagnostic interviews: a meta-research review. BMC Med. 2019;17:65.

    Article  Google Scholar 

  31. Recklitis CJ, Syrjala KL. Provision of integrated psychosocial services for cancer survivors post-treatment. Lancet Oncol. 2017;18:e39–50.

    Article  Google Scholar 

  32. Niedzwiedz CL, Knifton L, Robb KA, Katikireddi SV, Smith DJ. Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer. 2019;19:943.

    Article  Google Scholar 

  33. Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database Syst Rev. 2012;11:CD007064.

    PubMed  Google Scholar 

Download references


OB, PD, and KA acknowledge research support from the Medical Research Council (MRC) Centre for Transplantation and funding from the King’s Medical Research Trust (KMRT). PD further acknowledges funding from the King’s College London-Vattikuti Institute of Robotic Surgery and the Guy’s and St. Thomas’ (GSTT) Charity. KA further acknowledges funding from the Royal College of Surgeons of England, The Urology Foundation, Coptcoat Charity and the Pelican Foundation. RS is part-funded by: (1) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London; (2) a MRC Mental Health Data Pathfinder Award to King’s College London; (3) an NIHR Senior Investigator Award; (4) the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Author information

Authors and Affiliations



OB, SH, and KA contributed to the study concept and design. OB, SH, and AM contributed to the literature search and data collection. OB, GG, MVH, RS, and KA contributed to the data analysis and interpretation of the data. OB contributed to the drafting of the paper. OB, PD, RS, and KA contributed to the critical revision of the paper All authors approved the final paper for submission.

Corresponding author

Correspondence to Oliver Brunckhorst.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brunckhorst, O., Hashemi, S., Martin, A. et al. Depression, anxiety, and suicidality in patients with prostate cancer: a systematic review and meta-analysis of observational studies. Prostate Cancer Prostatic Dis 24, 281–289 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Further reading


Quick links