Suicide Risk In Men With Prostate-specific Antigen-Detected Early Prostate Cancer: A Nationwide Population-Based Cohort Study From PCBaSe Sweden
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UroToday.com - PSA screening remains controversial. In addition to questions over decreased mortality, concerns exist over the psychological trauma from an elevated PSA level and the results of a prostate biopsy. The ultimate tragic endpoint would be a patient committing suicide over a new diagnosis of prostate cancer (CaP). In the online version of European Urology, Anna Bill-Axelson and Swedish colleagues report that there is no increased risk of suicide among men with CaP diagnosed by PSA testing, but increased risk does exist for men with advanced CaP.
The study cohort is a combined Swedish database of men diagnosed with CaP between 1997 and 2006. Cross-linkage permitted identification of socio-economic variables and cause of death with these CaP patients. Among the 77,439 men in the database, 128 suicides were identified, for a suicide rate of 48.3 per 100,000 person-years. The corresponding age and standardized suicide rate in the general population was 31.9 per 100,000 person years and the expected number of suicides was 84.6 in this cohort, yielding a standardized mortality rate (SMR) of 1.5. For all age groups the risk of suicide significantly increased during the first and second years following diagnosis. There was a two-fold increase in suicide for men who had their CaP diagnosis made by a workup for symptoms, rather than by health control. No increased risk was found for men diagnosed with stage T1c or T2 tumors, but there was a two-fold increased risk in patients with stages T3-4 tumors (SMR 2.2). Increased risk of suicide was also found for men with a PSA >20ng/ml, Gleason score >5, and especially for men with a Gleason score 8-10. No increased risk was found for men planned for curative therapy or watchful waiting, but men receiving endocrine therapy had a higher SMR of 1.6. Increased suicide risk was observed among men diagnosed with CaP in both high and low socioeconomic statuses.
This study does not suggest that there is an increased risk of suicide among men diagnosed with early stage CaP detected by PSA testing. It does not assess stress among men who undergo PSA testing and are not found to have CaP. The study adds important information to the psycho-social impact of a CaP diagnosis.
Bill-Axelson A, Garmo H, Lambe M, Bratt O, Adolfsson J, Nyberg U, Steineck G, Stattin P
Eur Urol. 2009 Nov 10. Epub ahead of print.
Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
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