AUA 2018: The Prevalence and Biopsychosocial Predictors of Suicidality in Men with Prostate Cancer

San Francisco, CA ( Prostate cancer (PCa) is associated with a high rate of depression, more than that reported for the general population. There is a positive association between PCa diagnosis and suicide. The first aim of this study was to establish a point prevalence for suicidality among patients diagnosed with PCa. The second aim was to evaluate what biopsychosocial variables best predict greater risk of suicidality in men with PCa. 

For the purpose of this study, participants were recruited from the ambulatory PCa clinics at Queens University and through a direct invitation from an online PCa support group (Prostate Cancer Canada). All willing participants were directed to the online survey. Hierarchical regression was used to predict suicidality (SBQ-R), with the following variables included in the model: stage of PCa, length of diagnosis, number of comorbidities, number of treatments, exposure to suicide, functional, emotional and social well-being subscales of the FACT-P, hopelessness, stress catastrophizing, fears about death, and perceived interpersonal burdensomeness and thwarted belongingness scales (INQ-10). 

A total of 243 participants completed the survey. Of those 77% of participants were diagnosed with localized PCa and 23% with advanced PCa. The most common treatments received were prostatectomy (63%), radiotherapy (42%), and androgen-deprivation therapy (37%). Regarding suicidality, 16.9% were classified as at-risk cases using a general population cut-score, while 10.3% were classified as at-risk cases using an inpatient population cutoff. The regression analyses indicated that greater hopelessness (b=0.32) was the strongest predictor of suicidality. Previous exposure to suicide (b=0.26), reduced functional wellbeing (b=-0.21), higher exposure to suicide (b=0.26), shorter length of diagnosis (b=-0.16) and greater perceived burdensomeness (b=0.23) were all associated with increased suicidality. Cancer stage was not a significant predictor of suicide behaviors. 

In this important study, the authors concluded that although exposure to suicide, length of diagnosis and reduced functional well-being were associated with greater suicidality, perceived burdensomeness, or the extent to which individuals perceived themselves as a burden for their family and friends, and hopelessness, appear to be more salient clinical targets. Screening and identifying troublesome cognitive patterns in patients with PCa may be help in reducing suicidality.

Presented by: Jason Izard, Kingston, Canada
Co-Authors: D. Robert Siemens, Phylicia Verreault, Angela Black, Dean Tripp, Kingston, Canada

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA