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Depression and prostate cancer: implications for urologists and oncologists

Abstract

Many patients with prostate cancer experience severe levels of depression, which can negatively affect their treatment and disease course. Some prostate cancer treatments can increase the severity of a patient’s depression, for example, by increasing anhedonia and erectile dysfunction. Depression is often thought of as a unitary phenomenon, but multiple subtypes can be distinguished. This variety of manifestations challenges the successful application of universal antidepressant treatment options and argues for a multi-symptom assessment process that considers a patient’s disease burden and their particular form of depression. Inclusion of screening and detailed diagnosis of depression can be argued to be part of good practice, and clinicians are urged to consider when and how this might be accomplished within their urological practice.

Key points

  • Rates of depression among patients with prostate cancer are higher than in the general male population, principally owing to the uncertainty of treatment outcomes.

  • Depression can interfere with treatment outcomes, worsen a patient’s disease burden and increases treatment costs because of an increased risk of emergency room visits, outpatient services and hospitalizations.

  • Causal factors for depression include treatment modalities and adverse effects, genetic and biological factors, and psychological problems.

  • Associated factors for depression include patient sexuality, self-belief about coping with treatment, personality type and relationship status.

  • Depression is a heterogeneous disease and multiple subtypes can be distinguished, requiring targeted assessment strategies that focus on depression subtypes as well as overall depressive status.

  • Treatments for depression in men with prostate cancer include medication, psychotherapy, exercise and providing information, depending on the type of depression with which the patient presents.

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Fig. 1: Causal and associated factors in prostate cancer depression.
Fig. 2: Factors, considerations and responses when assessing depression in men with prostate cancer.

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C.F.S. and V. B. researched data for the article. All authors made substantial contributions to discussion of the article content, wrote and reviewed and/or edited the manuscript before submission.

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Sharpley, C.F., Christie, D.R.H. & Bitsika, V. Depression and prostate cancer: implications for urologists and oncologists. Nat Rev Urol 17, 571–585 (2020). https://doi.org/10.1038/s41585-020-0354-4

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