BERKELEY, CA (UroToday.com) - The prevalence of elevated levels of depressive symptoms among prostate cancer patients at different time points along the cancer trajectory is well documented. [1-5]
Although prostate cancer diagnosis can be devastating for patients and their families, little is known about how depressive symptoms at the time of diagnosis influence treatment outcomes in men with prostate cancer. In a first of its kind study, the authors find an association between clinically elevated depressive symptoms levels at the time of diagnosis, treatment modality (surgery versus radiation), and quality of life after treatment. The study results showed that about 20% of recently diagnosed prostate cancer patients reported clinically elevated levels of depressive symptoms before treatment. Depressive symptoms before treatment were higher among patients who opted for prostatectomy compared to those who opted for brachytherapy or external beam radiation therapy. Additionally, higher levels of depressive symptoms before treatment were associated with increased sexual and urinary dysfunction, increased urinary and sexual bother, and activity limitations due to urinary dysfunction after treatment.
The study results highlight the importance of treating depression at time of cancer diagnosis. Psychosocial or pharmacological interventions before prostate cancer treatment for a select sub-group of patients may significantly buffer the impact of treatment on the patient’s quality of life. However, most psychological measures of depression focus upon the presence of depressive symptomatology rather than the causes of depression.  Identifying the specific causal antecedents that lead to depression among certain groups of patients (e.g., young patients versus older patients) can help tailoring interventions to patients’ needs thus enhancing both the delivery and efficacy of these interventions. 
Additionally, clinicians should be sensitive to signs of depression during consultation and/or when patients report elevated levels of bother due to sexual and urinary dysfunction. Brief screening instruments (e.g., the brief version of the C-ESD) are readily available and could be administered by clinical or nursing staff without interruption of routine clinical care. Accompanying family members could also be queried about symptoms of depression. In addition, educating and training health care providers (physicians, nurses) on symptoms of depression might help identify patients in need of treatment, thus reducing its potential impact on QOL and recovery. Equally as important is timely and thorough patient education. Separating facts from fiction and dispelling myths about treatment outcomes for patients must be incorporated into treatment protocol. Healthcare providers should also discuss available treatment options for post -treatment incontinence and sexual dysfunction with their patients at the time of diagnosis and after treatment. Preparing newly diagnosed patients for potential deterioration in urinary and sexual function after treatment can help them adjust to loss of function and improve their coping with its emotional impact.
- Balderson N, Towell T. The prevalence and predictors of psychological distress in men with prostate cancer who are seeking support. Brit J Health Psychology 2003; 8: 125-30.
- Carlson L, Angen M, Cullum J et al. High levels of untreated distress and fatigue in cancer patients. Br J Cancer 2004; 90: 2297–2304.
- Kronenwetter C, Weidner G, Pettengill E et al. A qualitative analysis of interviews of men with early stage prostate cancer. Cancer Nurs 2005;28:99–107.
- Zabora J, Brintzenhofeszoc K, Curbow B, Hooker C,Piantadosi S. The prevalence of psychological distress by cancer site. Psycho-Oncology 2001;10:19–28.
- Llorente MD, Burke M, Gregory G et al. Prostate cancer: a significant risk factor for late-life suicide. Am J Geriatr Psychiatry 2005;13:195–201.
- Sharpley CF, Bitsika V, Christie DR. Understanding the causes of depression among prostate cancer patients: development of the effects of prostate cancer on lifestyle questionnaire. Psycho-Oncology 2009;18:162–16
Kathy Gilbert, MS, MBA as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.