Hormonal treatment can help control prostate cancer but may increase a man’s risk of depression, a new study by Danish researchers suggests.
Male hormones, such as testosterone, are known to fuel the growth of prostate tumors. So doctors use drugs to reduce hormone production. But that can bring on tough side effects, such as incontinence or impotence.
The new study found that men on hormone-reducing therapy after having their prostate removed were 80 percent more likely to develop depression than other prostate cancer patients.
“Continuous awareness about signs of depression in prostate cancer patients, even many years after diagnosis — and in particular, in case of treatment with androgen-deprivation therapy — is warranted,” said lead researcher Dr. Anne Sofie Friberg, of Copenhagen University Hospital.
Many men with cancer become depressed, but it’s especially true for those with prostate cancer because treatment often affects their sexual functioning.
This study can’t prove that hormonal treatment alone is a cause of depression, but it likely plays a part, Friberg said.
“Our results indicate that prostate cancer patients are vulnerable to depression,” she said. “The association depends on many factors, and our results imply that treatment for recurrence contributes substantially to the risk.”
For the study, Friberg’s team collected data on nearly 5,600 men listed in the Danish Prostate Cancer Registry.
Just over 770 of them were treated for depression. The study found that men who were treated with hormone-reducing medicines had nearly twice the risk of depression, compared with other patients. The increased risk remained for all 18 years of follow-up, Friberg said.
The findings were strongest for men whose prostate was surgically removed. The results were inconclusive for men who had radiation therapy, the researchers said.
Men who have their prostate removed often suffer side effects such as erectile dysfunction and urinary incontinence that increase their likelihood for depression. As many as one-quarter of these surgical patients will see their cancer return and may then undergo hormone-reducing treatment.
The treatment blocks testosterone, can alter libido, cause hot flashes and affect mood, all of which add to depression risk, the study authors said.
The study findings were presented Monday at a meeting of the European Association of Urology, in Barcelona, Spain. Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Dr. Anthony D’Amico, a professor of radiation oncology at Harvard Medical School in Boston, called the study conclusions into question. He noted that many men on hormone-reducing therapy are prescribed the antidepressant Effexor (venlafaxine) to control resulting hot flashes.
“This study is not definitive, because the number one treatment for hot flashes is antidepressant medication,” D’Amico said.
The prostate patients most likely to develop depression are those with a history of depression, he added.
Although the study may overstate the effect of hormone-reducing treatment on depression, D’Amico said doctors should be aware that their patients are at risk and may need treatment for it.
What Is Prostate Cancer?
Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer cells, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?
Prostate cancer begins when cells in the prostate gland start to grow uncontrollably. The prostate is a gland found only in males. It makes some of the fluid that is part of semen.
The prostate is below the bladder and in front of the rectum. The size of the prostate changes with age. In younger men, it is about the size of a walnut, but it can be much larger in older men.
Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate.
Types of prostate cancer
Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen).
Other types of prostate cancer include:
Small cell carcinomas
Neuroendocrine tumors (other than small cell carcinomas)
Transitional cell carcinomas
These other types of prostate cancer are rare. If you have prostate cancer it is almost certain to be an adenocarcinoma.
Some prostate cancers can grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men (and even some younger men) who died of other causes also had prostate cancer that never affected them during their lives. In many cases neither they nor their doctors even knew they had it.
Possible pre-cancerous conditions of the prostate
Some research suggests that prostate cancer starts out as a pre-cancerous condition, although this is not yet known for sure. These conditions are sometimes found when a man has a prostate biopsy (removal of small pieces of the prostate to look for cancer).
Prostatic intraepithelial neoplasia (PIN)
In PIN, there are changes in how the prostate gland cells look under a microscope, but the abnormal cells don’t look like they are growing into other parts of the prostate (like cancer cells would). Based on how abnormal the patterns of cells look, they are classified as:
Low-grade PIN: the patterns of prostate cells appear almost normal
High-grade PIN: the patterns of cells look more abnormal
PIN begins to appear in the prostates of some men as early as in their 20s.
Many men begin to develop low-grade PIN when they are younger but don’t necessarily develop prostate cancer. The possible link between low-grade PIN and prostate cancer is still unclear.
If high-grade PIN is found in your prostate biopsy sample, there is about a 20% chance that you also have cancer in another area of your prostate.
Proliferative inflammatory atrophy (PIA)
In PIA, the prostate cells look smaller than normal, and there are signs of inflammation in the area. PIA is not cancer, but researchers believe that PIA may sometimes lead to high-grade PIN, or perhaps to prostate cancer directly.