Current Mental Distress Among Men With a History of Radical Prostatectomy and Related Adverse Correlates

Abstract

Recent reviews and observational studies have reported that patients with prostate cancer (PCa) are at increased risk of mental health issues, which in turn negatively affects oncological outcomes. Here, we examine possible explanatory variables of mental distress in a population-based cohort of men who have undergone radical prostatectomy (RP). Data were derived from a Maritimes-Canada online survey assessing patient-reported quality of life outcomes between 2017 and 2019 administered to 136 men (47–88 years old, currently in a relationship) who have undergone RP for their PCa diagnosis. The primary outcome was a validated assessment of mental distress, the Kessler Psychological Distress Scale (K10). Urinary function was assessed using the International Prostate Symptom Score, and relationship satisfaction was assessed using the Dyadic Assessment Scale. A multivariate logistic regression assessed the contribution of urinary function, relationship satisfaction, age, multimorbidity, additional treatments, medication for depression and/or anxiety, and survivorship time. A total of 16.2% men in this sample screened positive for mental distress. The severity of urinary problems was positively associated with increased mental distress ( OR = 4.79, 95% CI [1.04, 22.03]), while increased age ( OR = 0.87, 95% CI [0.78, 0.97]), relationship satisfaction ( OR = 0.14, 95% CI [0.3, .077]), and current medication for anxiety, depression, or both ( OR = 0.09, 95% CI [0.02, 0.62]) were protective factors. Survivorship time, the presence of additional comorbidities, or PCa treatments were not identified to be statistically significant contributions to the fitted model. Here, we report that RP survivors are prone to presenting with increased mental distress long after treatment. Screening for mental distress during RP survivorship is recommended.

Assessment of Current Mental Health Status in a Population-Based Sample of Canadian Men With and Without a History of Prostate Cancer Diagnosis: An Analysis of the Canadian Longitudinal Study on Aging (CLSA)

“…Covariate results from our final analysis also indicate that younger age, not being currently in a relationship, lower household income, and residing in Atlantic Canada may be placing men at higher odds of mental health disorder than being of older age, being currently in a relationship, of over 150,000$ in household income and residing in Alberta. These results are not surprising and are comparable to other studies ( 5 , 11 , 20 , 50 , 56 ).…”

“…Leaving mental health needs unattended leads to poor quality of life among PCa survivors, poor oncological outcomes, and could potentially burden health care systems (6)(7)(8)(9)(10)(11). In light of the current and recent studies, the necessity of assessing patients' needs as they emerge after the diagnosis and treatment, understanding the role treatment modalities play in their development, and creating survivorship care plans that address these needs including earlier interventions in the form of pre-habilitation as well as survivorship programs is evident (11,20,57,58).…”

“…Results observed here, point to the need to develop multidisciplinary survivorship care teams that include mental health care experts who can diagnose and treat patients and survivors in need of mental health support. They also point to the need to develop patient education and empowerment interventions for programs and survivors that address directly their psychosocial oncological needs, including, but not limited to, unmet emotional needs (e.g., loss of sexual function and unmet intimacy needs), social isolation, and lack of social support ( 11 , 20 , 49 , 59 ). Results here indicate that preventative efforts to reduce the mental health burden during PCa survivorship are warranted.…”

“…In the past few years, we have seen an increase in the number of studies that are beginning to assess the role of psychosocial factors on the mental health and quality of life of prostate cancer survivors ( 11 , 20 ). For example, a study looking at prostate cancer survivorship among married men (or currently in a relationship) who had undergone surgery for their prostate cancer diagnosis, found that 16.2% of the men in the sample also screened positive for psychological distress ( 20 ). This outcome was worse for men who were of younger age, those who scored low on relationship satisfaction, and were not, at the time the study was conducted, on prescribed medication for anxiety, depression, or both ( 20 ).…”

An Examination of the Role of Socioeconomic Status in the Relationship between Depression and Prostate Cancer Survivorship in a Population-Based Sample of Men from Atlantic Canada

“…Surgical and/or radiation therapy complications, together with hormonal therapy, pose significant challenges to patients and may contribute, by means of the stress response they elicit, to the onset of mental distress and depression [41]. Stressors such as urinary incontinence, erectile disfunction (total or partial), and worries about sexual function and intimacy have also been shown to increase mental distress among patients and survivors of prostate cancer [42, 43]. Future studies should consider investigating the role of stress and the negative emotions they elicit in the relationship between prostate cancer survivorship and the development of depression, quality of life, and possible downstream immunological influences on survival rates.…”