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JU INSIGHT Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes

By: Amy N. Luckenbaugh, MD; Christopher J.D. Wallis, MD, PhD; Li-Ching Huang, PhD; Daniela Wittmann, PhD; Zachary Klaassen, MD; Zighuo Zhao, MS; Tatsuki Koyama, PhD; Aaron A. Laviana, MD, MBA; Ralph Conwill; Michael Goodman MD, MPH; Ann S. Hamilton, PhD; Xiao-Cheng Wu, MD, MPH; Lisa E. Paddock, PhD; Antoinette Stroup, PhD; Matthew R. Cooperberg, MD, MPH; Mia Hashibe, PhD; Brock B. O'Neil, MD; Sherrie H. Kaplan, PhD; Sheldon Greenfield, MD; Karen E. Hoffman, MD, M.H.Sc, MPH; David F. Penson, MD, MPH; Daniel A. Barocas, MD, MPH | Posted on: 01 May 2022

Luckenbaugh AN, Wallis CJD, Huang Li-C et al: Association between treatment for localized prostate cancer and mental health outcomes. J Urol 2022;

Description: Graphical user interface, applicationDescription automatically generated
Figure. Trend in unadjusted CES-D and SF-36 scores by treatment modality over time. ADT, androgen deprivation therapy.

Study Need and Importance

The absolute differences in cancer-specific and overall mortality between treatment modalities (active surveillance, radical prostatectomy and radiotherapy with or without androgen deprivation therapy) for localized prostate cancer are small, and thus, treatment-related morbidity is carefully considered when making treatment decisions. Mental health outcomes in these patients have been poorly explored; therefore, we evaluated the association between prostate cancer treatment type and patient-reported depression and emotional well-being over time using previously validated Centers for Epidemiologic Studies Depression (CES-D) and Medical Outcomes Study 36-item Short Form survey (SF-36) scores from the prospective population-based CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study.

What We Found

We found no effect of treatment modality on depressive symptoms (see figure). However, we identified a number of factors associated with declines in mental health regardless of treatment type, including older age, poorer health, being unmarried and having lower baseline CES-D scores.


This is an observational study, and thus treatment choice is nonrandom, which can lead to confounding. Additionally, the CES-D and SF-36 have been validated in a general population, but not in a prostate cancer-specific population and thus may fail to detect small differences between treatment groups. Finally, using active surveillance as the referent group may contribute to the limited impact of treatment modality on mental health outcomes, as it is possible that there is a large mental health burden for those on active surveillance with prostate cancer.

Interpretation for Patient Care

Although we did not find clinically important differences in mental health outcomes for men with localized prostate cancer based on treatment received, we did identify several patient characteristics associated with poorer mental health outcomes. These characteristics may allow for early identification of patients who are most at risk for adverse mental health outcomes following prostate cancer treatment.