Men diagnosed with locally advanced or metastatic prostate cancer after a workup of symptoms have a suicide rate twice that of men in the general population, Swedish researchers reported.

The suicide rate is not increased among men who have nonpalpable T1c prostate tumors diagnosed subsequent to a PSA test.

Using the Prostate Cancer Base Sweden database, investigators identified 128 suicides among 77,439 prostate cancer patients, or an overall 1.5 times greater rate than the expected number of 85, according to a report in European Urology (2009; published online ahead of print). The rate was not increased among men with PSA-detected T1c tumors, but was 2.1 times higher among men diagnosed with locally advanced or metastatic disease.

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Among men with high socioeconomic status (SES), 32% were diagnosed with T1c tumors and 27.2% had locally advanced tumors at diagnosis. The proportions were 26.1% and 31.8%, respectively, for men with low SES.

Of the 77,439 patients, 22,405 had PSA-detected T1c tumors, 22,929 had locally advanced disease, and 8,350 had distant metastases.

The investigators, led by Anna Bill-Axelson, MD, of University Hospital in Uppsala and the Karolinska Institute in Stockholm, observed that evidence indicates that the risk of suicide is increased in cancer patients, including men with prostate cancer. It has been unclear whether this increased risk exists for all stages of prostate cancer, including early nonpalpable tumors detected by PSA testing.

She and her colleagues concluded that the increased suicide risk in men with prostate cancer was not due to an increase in suicide risk for men with PSA-detected tumors. The finding of an increased risk of suicide among men with advanced and metastatic disease “is important to acknowledge in order to focus on the need to identify signs of depression and optimize treatment among this category of patients,” they wrote.