Prognostic factors for mental wellbeing in prostate cancer: A systematic review and meta‐analysis

Abstract

ObjectivesTo evaluate the evidence base for patient, oncological, and treatment prognostic factors associated with multiple mental wellbeing outcomes in prostate cancer patients.MethodsWe performed a literature search of MEDLINE, EMBASE, and CINAHL databases including studies evaluating patient, oncological, or treatment factors against one of five mental wellbeing outcomes; depression, anxiety, fear of cancer recurrence, masculinity, and body image perception. Data synthesis included a random effects meta‐analysis for the prognostic effect of individual factors if sufficient homogenous data was available, with a structured narrative synthesis where this was not possible.ResultsA final 62 articles were included. Older age was associated with a reducing odds of depression (OR 0.97, p = 0.04), with little evidence of effect for other outcomes. Additionally, baseline mental health status was related to depression and increasing time since diagnosis was associated with reducing fear of recurrence, albeith with low certainty of evidence. However, few other patient or oncological factors demonstrated any coherent relationship with any wellbeing outcome. Androgen deprivation therapy was associated with increased depression (HR 1.65, 95% CI 1.41–1.92, p < 0.01) and anxiety, however, little difference was seen between other treatment options. Overall, whilst numerous factors were identified, most were evaluated by single studies with few evaluating masculinity and body image outcomes.ConclusionWe highlight the existing evidence for prognostic factors in mental wellbeing outcomes in prostate cancer, allowing us to consider high‐risk groups of patients for preventative and treatment measures. However, the current evidence is heterogenous with further work required exploring less conclusive factors and outcomes.

The mediating effect of self-efficacy on family functioning and psychological resilience in prostate cancer patients

“…European Association of Urology and the American Association of Urology have recognized a decline in the quality of life and mental health of prostate cancer patients, with their psychological state becoming an increasingly important factor in clinical assessment (Vyas et al, 2023 ). This study has several implications for clinical practice with prostate cancer patients.…”

Five‐year outcomes of fractionated stereotactic body radiotherapy for oligometastatic prostate cancer from the TRANSFORM phase II trial

“…Escalation to ADT represents a significant milestone in the progression and treatment of PCa and is associated with well-documented psychological and physical adverse effects which negatively impact quality of life. [1][2][3][4] Delaying the commencement of initial ADT and the inevitable progression to castration resistance may be considered favourable for men with comorbidities that inhibit the use of first-or second-line chemotherapy and men who express the strong desire to preserve their quality of life. Once ADT is commenced, the median time to progress to a castration-resistant state is approximately 2-3 years, 5,6 at which point progression to androgen receptor signalling inhibitors or chemotherapeutic agents such as abiraterone, enzalutamide or docetaxel is required, which is associated with further deleterious effects.…”

“…Androgen deprivation therapy (ADT) remains at the core of managing metastatic prostate cancer (PCa). Escalation to ADT represents a significant milestone in the progression and treatment of PCa and is associated with well‐documented psychological and physical adverse effects which negatively impact quality of life 1–4 …”