Localized prostate cancer treatment modality does not affect men’s mental health, a new study finds.

In the prospective, population-based CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study of 2742 patients, investigators evaluated the association between prostate cancer treatment type and patient-reported depression, emotional wellbeing, and fatigue.

Baseline depressive symptoms, as measured by the Centers for Epidemiologic Studies Depression (CES-D), was low in the cohort with a median score of 4 out of a possible 27. Over 5 years of follow-up, CES-D scores did not differ significantly for men receiving radiation therapy (with or without androgen deprivation therapy) or radical prostatectomy, compared with active surveillance, Amy N. Luckenbaugh, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues reported in The Journal of Urology. Treatment modality also did not influence scores for emotional wellbeing or energy/fatigue on the Medical Outcomes Study 36-item Short Form survey (SF-36).

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Investigators did find mental health decline among certain men. On multivariable analysis, increasing CES-D score was significantly associated with higher CES-D score at baseline, older age, greater comorbidity burden, poor overall health and physical function, unmarried status, lower income, and lower participatory decision-making score at baseline. Similar factors were significantly associated with decline in emotional health over time.

“While psychological interventions are beyond the scope of most clinicians treating prostate cancer, we ought to appropriately screen and subsequently refer those at risk,” according to Dr Luckenbaugh’s team.

The investigators acknowledged that using the active surveillance group as the referent may have limited study findings compared with using healthy men without a cancer diagnosis.


Luckenbaugh AN, Wallis CJD, Huang LC, et al. Treatment for localized prostate cancer and mental health outcomes. J Urol. Published online March 3, 2022. doi:10.1097/JU.0000000000002370