ADT-Related Anxiety Linked to Elevated PSA

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Men with elevated serum PSA levels prior to beginning androgen deprivation therapy (ADT) for prostate cancer are nearly eight times more likely to experience anxiety after starting ADT, researchers reported.

Previous research has shown that men with prostate cancer are at increased risk for mental illness, but no one had yet identified specifically which illnesses are most likely to occur and why. In the new study, published in The Canadian Journal of Urology (2008;15:4249-4256), researchers showed that men with elevated serum PSA levels before ADT  have a nearly eight times higher risk of developing anxiety.

“We hypothesize that patients with [higher levels of] serum PSA at the time of diagnosis may suffer from greater anxiety due to the presence of more advanced disease,” said lead investigator Christopher DiBlasio, MD, a staff urologist at North Shore Medical Group/Mount Sinai University School of Medicine in Huntington, N.Y and University of Tennessee Health Sciences Center in Memphis, Tenn.

Dr. DiBlasio and 10 collaborators retrospectively reviewed the records of all men who received ADT for prostate cancer—except for those receiving only neoadjuvant ADT—at the University of Tennessee Health Science Center in Memphis between January 1989 and July 2005.

Among the 395 men included in the study, 34 (8.6%) had a psychiatric illness before starting ADT and 101 (27.9%) were diagnosed with new-onset psychiatric illness after starting ADT. In these patients, the most common illnesses were depression (57 patients [56.4%]), dementia (14 patients [13.9%]), and anxiety (nine patients [8.9%]).

In its initial analysis, Dr. DiBlasio's team found several factors were associated with a higher probability of developing a new-onset psychiatric illness, including longer mean duration of ADT. After multivariate analysis, the only significant association they found was between pre-ADT PSA level and post-ADT anxiety.

Dr. DiBlasio recommends that patients starting ADT be serially monitored for development of mental illnesses. By employing validated instruments for screening this population in the clinic setting, early detection and treatment with counselling and/or pharmacotherapy, where appropriate, can be initiated in a timely fashion.
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