title: Suicide risk in men with prostate-specific antigen-detected early prostate cancer: a nationwide population-based cohort study from PCBaSe Sweden.
abstract: BACKGROUND
  The risk of suicide is increased among cancer patients including men with prostate cancer (PCa). However, whether this increased risk applies to men diagnosed subsequent to prostate-specific antigen (PSA) testing is not known.
  
  
  OBJECTIVE
  To assess the risk of suicide among men diagnosed with PCa subsequent to PSA testing.
  
  
  METHODS
  The Prostate Cancer Base Sweden (PCBaSe Sweden) database, the Swedish Cause of Death Register, and the Swedish census database were used. The PCBaSe Sweden is a merged database that includes data from the Swedish National Prostate Cancer Register (NPCR) for cases diagnosed between January 1, 1997, and December 31, 2006. The number of suicides registered for cases in the PCBaSe cohort was compared with the expected number of suicides in an age-matched general male Swedish population.
  
  
  METHODS
  Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for different categories of cases.
  
  
  CONCLUSIONS
  There were 128 suicides among the 77,439 PCa cases in the NPCR compared with an expected number of 85 (SMR: 1.5; 95% CI, 1.3-1.8). The risk of suicide was not increased for the 22,405 men with PSA-detected T1c tumours (SMR: 1.0; 95% CI, 0.6-1.5), whereas the 22,929 men with locally advanced nonmetastatic tumours (SMR: 2.2; 95% CI, 1.6-2.9) and the 8350 men with distant metastases (SMR: 2.1; 95% CI, 1.2-3.6) had statistically significant increased SMRs for suicide. Potential effects of comorbid medical and psychiatric conditions could not be investigated.
  
  
  CONCLUSIONS
  No increased risk of committing suicide was observed among men with PCa diagnosed subsequent to PSA testing, whereas the risk was twice as high among men with locally advanced or metastatic disease, compared with an age-matched male population.
authors.affiliation: Department of Urology, University Hospital, Uppsala, Sweden. anna.bill.axelson@akademiska.se
authors.forename: Anna
authors.initials: A
authors.lastname: Bill-Axelson
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
authors.forename: Jan
authors.initials: J
authors.lastname: Adolfsson
authors.forename: Ullakarin
authors.initials: U
authors.lastname: Nyberg
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000150:complications*; D018570:Risk Assessment; D013405:Suicide / Q000706:statistics & numerical data*
chemical_list: D017430:Prostate-Specific Antigen