Can treatment of prostate cancer cause depression?

By Melisa Silver

Well, not in all cases, but treating prostate cancer with hormone replacement therapy that aims at suppressing testosterone and DHT can increase the likelihood of depression in the elderly.

A new study suggests that elderly men who receive androgen-suppressing therapy for treating prostate cancers are likely to develop depression. This theory emerged as a result of positive findings in a study that comprised of over 78,000 U.S men who were being treated for early stages of prostate cancer. The research results revealed that out of the selected population, 7 percent of those who were receiving hormonal therapy for prostate cancer developed clinical depression in the course of next few years.

Dr. Paul Nguyen, who is a senior researcher and the director of prostate brachytherapy at Brigham and Women’s Hospital, in Boston says that the findings do not prove that hormone therapy is to blame. But they do offer “pretty strong evidence”. According to Nguyen, the longer is the duration of hormonal therapy, the more are the chances of development of depression.

Investigators also discovered that among the subjects who were treated by hormone suppressing methods for a period of six months or less, 6 percent developed depression within a course of three years from their diagnosis. The figure had raised to 8 percent in those subjects who were receiving the therapy for almost an year.

According to Nguyen, depression could be the direct effect of reduction in testosterone levels on the patient’s mood, however there could be some indirect influences as well.

Although depression in cancer patients is a big concern, but this side effects of hormonal therapy in prostate cancer outweighs its benefits by many folds.

It is said that prostate cancer is the commonest of its type in the male population of the United States, after skin cancer. Adenocarcinoma is its commonest variant. Apart from this, other kinds of prostate cancer that have been observed till date are sarcomas, neuroendocrine tumors, transitional cell carcinomas and small cell carcinomas.

Who can get a prostate cancer?

Risk factors for the disease include family history (the strongest factor) and presence of certain pre-cancerous conditions. So what could be these pre-cancerous conditions whose early detection can prevent the occurrence of this wrath? Well, prostatic intraepithelial cell neoplasia (PIN), a condition in which the prostate cells have started developing neoplastic abnormalities, puts one into the doldrums of high-risks of developing the associated cancer. About 16% of men if biopsied for their prostates, are likely to have PIN. PIN is of two types: low-grade and high-grade. Not everyone who has low-grade PIN shall develop cancer, however high-grade PIN increases the likelihood. Proliferative inflammatory atrophy (PIA) is yet another condition that makes one prone towards prostate carcinoma development. In PIA, the size of prostate cells decreases (atrophies), and the organ exhibits signs of inflammation. PIA directly doesn’t lead to cancer. Instead, it is believed that PIA converts into PIN of high-grade, and that increases the risk for prostate cancer.

The African American race is more likely at the risk of this cancer.

How is prostate cancer treated?

Fortunately, this cancer does not grow and spread too quickly and in most of the cases, early diagnosis and treatment decreases mortality due to prostate cancer.

Treatment of prostate cancer first requires a proper diagnosis which is evaluated by certain lab tests, physical examination and clinical symptoms. Since the organ is situated directly beneath the bladder, any obstructive difficulty in urination rises the suspicion. Lab exam for prostate cancer includes the detection of prostate specific antigen (PSA) in blood, prostate ultrasound and histopathological tests (biopsy).

Various therapeutic interventions have been devised for the treatment of prostate cancer. These include radiation therapy, chemotherapy, vaccination, bone-directed therapy, cryotherapy, and hormonal therapy. Of all these, we shall discuss the hormone-directed treatment of prostate cancer in detail.

Hormonal therapy for prostate cancer:

Prostate cells grow and function in response to the male hormones called ‘androgen’. Same is the case with prostate cancer cells. They too grow and divide under the influence of this hormone. Hence, the main aim of hormone-directed therapy for prostate cancer is to suppress this androgen so to deprive the cancerous cells from the growth signals they receive in presence of these hormones. Hence, it is also known as ‘androgen-suppression’ or ‘androgen-deprivation’ treatment.

The main androgen of the male body are testosterone and dihyrotestosterone (DHT). Hormone therapy is indicated when the prostate cancer has recurred, in association with radiotherapy for preventing recurrence, if the cancer has spread so much so that other therapeutic measures won’t benefit the patient, before inducing radiations so that the tumor size shrinks and gets easily removed, etc.

REFERENCE: Hormone therapy for prostate cancer tied to depression