title: Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer.
abstract: OBJECTIVE
  Although demographic, clinicopathologic, and socioeconomic differences may affect treatment and outcomes of prostate cancer, the effect of mental health disorders remains unclear. We assessed the effect of previously diagnosed depression on outcomes of men with newly diagnosed prostate cancer.
  
  
  METHODS
  We performed a population-based observational cohort study using Surveillance, Epidemiology, and End Results-Medicare linked data of 41,275 men diagnosed with clinically localized prostate cancer from 2004 to 2007. We identified 1,894 men with a depressive disorder in the 2 years before the prostate cancer diagnosis and determined its effect on treatment and survival.
  
  
  RESULTS
  Men with depressive disorder were older, white or Hispanic, unmarried, resided in nonmetropolitan areas and areas of lower median income, and had more comorbidities (P < .05 for all), but there was no variation in clinicopathologic characteristics. In adjusted analyses, men with depressive disorder were more likely to undergo expectant management for low-, intermediate-, and high-risk disease (P ≤ .05, respectively). Conversely, depressed men were less likely to undergo definitive therapy (surgery or radiation) across all risk strata (P < .01, respectively). Depressed men experienced worse overall mortality across risk strata (low: relative risk [RR], 1.86; 95% CI, 1.48 to 2.33; P < .001; intermediate: RR, 1.25; 95% CI, 1.06 to 1.49; P = .01; high: RR, 1.16; 95% CI, 1.03 to 1.32; P = .02).
  
  
  CONCLUSIONS
  Men with intermediate- or high-risk prostate cancer and a recent diagnosis of depression are less likely to undergo definitive treatment and experience worse overall survival. The effect of depression disorders on prostate cancer treatment and survivorship warrants further study, because both conditions are relatively common in men in the United States.
authors.affiliation: Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Sandip M
authors.initials: SM
authors.lastname: Prasad
authors.affiliation: Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.affiliation: Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Irwin
authors.affiliation: Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.affiliation: Sandip M. Prasad, Medical University of South Carolina, Charleston, SC; Scott E. Eggener, University of Chicago Medical Center, Chicago, IL; Stuart R. Lipsitz, Brigham and Women's Hospital, Boston, MA; Michael R. Irwin and Patricia A. Ganz, David Geffen School of Medicine at the University of California, Los Angeles; and Jim C. Hu, University of California, Los Angeles, Los Angeles, CA. jchu@mednet.ucla.edu.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D018426:SEER Program; D014481:United States / Q000453:epidemiology