Mental health issues (MHI) develop in one-fifth of elderly men with localized prostate cancer (PCa), with those who undergo radical prostatectomy or radiotherapy at lower risk for MHI than those on watchful waiting, according to a new study.

The study, by Praful Ravi, MBBChir, of Imperial College Healthcare NHS Trust, London, and colleagues, included 50,856 men aged 65 years or older with localized PCa diagnosed from 1992 to 2005 and without a mental illness diagnosis at baseline. MHI developed in 10,389 patients (20.4%) during the study period, the investigators reported online ahead of print in Urologic Oncology.

Compared with men aged 65–69 years, those aged 75 years or older had a significant 29% increased risk of MHI, such as anxiety, major depressive disorder, and neurotic depression. Compared with patients who had a Charlson comorbidity index of 0, those with an index of 1, 2, or 3 or more had a significant 23%, 39%, and 63% increased risk, respectively.

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Men who underwent radical prostatectomy (RP) and radiotherapy (RT) had a significant 21% and 15% lower risk of MHI, respectively, compared with patients who underwent watchful waiting (WW). Urinary incontinence was associated with a significant 47% increased risk of MHI, where erectile dysfunction was associated with a significant 10% decreased risk.

The median time to development of MHI was significantly greater in men who underwent RP than in those who underwent RT (not reached vs. 182 months) or WW (not reached vs. 180 months).

MHI rates at 10 years were 29.7%, 29.0%, and 22.6% among patients undergoing WW, RT, and RP, respectively.

“We feel that watchful waiting was associated with a higher risk of mental health issues because patients may feel their cancer is not being definitively managed,” Dr. Ravi told Renal & Urology News. “This could again explain why median time to development of MHI was greater for RP compared to WW. Additionally, the later development of toxicity with RT may also explain why median time to development of MHI was longer for RP compared to RT.”