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Studies reveal elevated risk of cardiovascular death and suicide.

 

SAN FRANCISCO—Men recently diagnosed with prostate cancer are at elevated risk of cardiovascular death and suicide, according to separate analyses of a cohort of Swedish men.

 

The risk of both is highest within a week after men receive their diagnosis and among men aged 54 years and younger, researchers reported here at the 2008 Genitourinary Cancers Symposium. The studies were conducted by investigators at the Karolinska Institutet in Stockholm, Sweden, the University of Iceland in Reykjavik, and the Harvard School of Public Health in Boston.

Compared with men without a prostate cancer diagnosis, those diagnosed with the malignancy had an overall 50% increased risk of cardiovascular death and a 2.6 times higher risk of suicide. Compared with men who had a previous history of CVD, those without such a history had a higher risk of cardiovascular death.

 

The study population included 5,225,878 men, of whom 149,982 had prostate cancer. Investigators followed prostate cancer patients from the date of diagnosis to one year following the diagnosis.

 

Compared with men without prostate cancer, men aged 54 years or less were at nearly nine times higher risk of death from cardiovascular causes. The risk decreased with age, with prostate cancer patients aged 55-64, 65-74, and 75 years and older at 2.2, 1.7, and 1.3 times higher risk, respectively. The risk of cardiovascular death was about eight times higher within seven days after diagnosis; it was 3.6, 1.4, and 1.1 times higher 8-28, 29-183, and 184-366 days after diagnosis.

 

Men aged 54 years or less were at five times higher risk of suicide compared with men without prostate cancer. The risk was nearly twofold higher among men aged 55-64 and 2.7 and 2.6 times higher among men aged 65-74 and 75 years and older, respectively. Suicide risk was eight times higher within seven days of diagnosis, and 2.7, 3.0, and 1.9 times higher 8-28, 29-183, and 184-366 days after diagnosis, respectively, compared with men without prostate cancer. Suicide risk was slightly greater in men without partners and in those with a lower education level.

The investigators said the increased risk of cardiovascular deaths and suicides immediately following a prostate cancer diagnosis illustrates that such a diagnosis is a severely stressful event. This vulnerable group of patients may benefit from careful delivery of the diagnostic message and supportive services offered immediately after the diagnosis, the researchers concluded.

 

The symposium was sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiation and Oncology, and the Society of Urologic Oncology. The new studies are not the first to examine the psychological impact of a prostate cancer diagnosis.

 

In 2006, Australian researchers led by Jeremy W. Couper, MD, head of psychiatry at the Peter MacCallum Cancer Centre in East Melbourne, Australia, reported on the psychological distress faced by patients and their partners. In the study, 103 couples filled out questionnaires at the time of cancer diagnosis (Time 1) and again six months later (Time 2).

 

Patients and partners also were interviewed. At Time 1, partners had rates of major depression and generalized anxiety disorder twice those of women in the Australian community, and considerably higher than the patients' rates, Dr. Couper's group reported in the Medical Journal of Australia (2006;185:428-432). At Time 2, psychological distress had lessened in partners but increased in patients.

 

Commenting on the study of the effect of a prostate cancer diagnosis on fatal cardiovascular events, Dr. Couper told Renal & Urology News it is unclear whether the study had taken into account certain potential confounders.

 

For example, men diagnosed with the malignancy may have visited their doctor for another reason, such as symptoms related to an undiagnosed cardiac condition. Prostate cancer might have been diagnosed incidentally, making it appear that the prostate cancer diagnosis was the cause of cardiovascular death, he observed. He said he finds the study of suicide rates more compelling because he does not see much potential for confounding.

 

The new studies suggest that “in-creased rates of suicide and, potentially, fatal cardiovascular events, in the aftermath of learning of a diagnosis of prostate cancer, are the most alarming tip of an iceberg of psychological distress that occurs in men facing a diagnosis of prostate cancer,” Dr. Couper said.

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