title: Mental health outcomes in elderly men with prostate cancer.
abstract: OBJECTIVE
  To examine the burden of mental health issues (MHI), namely anxiety, depressive disorders, and suicide, in a population-based cohort of older men with localized prostate cancer and to evaluate associations with primary treatment modality.
  
  
  METHODS
  A total of 50,856 men, who were 65 years of age or older with clinically localized prostate cancer diagnosed between 1992 and 2005 and without a diagnosis of mental illness at baseline, were abstracted from the Surveillance, Epidemiology, and End Results-Medicare database. The primary outcome of interest was the development of MHI (anxiety, major depressive disorder, depressive disorder not elsewhere classified, neurotic depression, adjustment disorder with depressed mood, and suicide) after the diagnosis of prostate cancer.
  
  
  RESULTS
  A total of 10,389 men (20.4%) developed MHI during the study period. Independent risk factors for MHI included age ≥ 75 years (hazard ratio [HR] = 1.29); higher comorbidity (Charlson comorbidity index ≥ 3, HR = 1.63); rural hospital location (HR = 1.14); being single, divorced, or widowed (HR = 1.12); later year of diagnosis (HR = 1.05); and urinary incontinence (HR = 1.47). Black race (HR = 0.79), very high-income status (HR = 0.87), and definitive treatment (radical prostatectomy [RP], HR = 0.79; radiotherapy [RT], HR= 0.85, all P<0.001) predicted a lower risk of MHI. The rates of MHI at 10 years were 29.7%, 29.0%, and 22.6% in men undergoing watchful waiting (WW), RT, and RP, respectively.
  
  
  CONCLUSIONS
  Older men with localized prostate cancer had a significant burden of MHI. Men treated with RP or RT were at a lower risk of developing MHI, compared with those undergoing WW, with median time to development of MHI being significantly greater in those undergoing RP compared with those undergoing RT or WW.
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: prafulravi1987@gmail.com.
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, Ruhr University Bochum, Marienhospital, Herne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Department of Oncology, Dana-Farber Cancer Institute, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Oncology, Dana-Farber Cancer Institute, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Rana R
authors.initials: RR
authors.lastname: McKay
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Division of Urologic Surgery, Brigham and Women׳s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Briony
authors.initials: B
authors.lastname: Varda
authors.affiliation: Division of Urologic Surgery, Brigham and Women׳s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chang
authors.affiliation: Division of Urologic Surgery, Brigham and Women׳s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Division of Urologic Surgery, Brigham and Women׳s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women׳s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008603:Mental Health; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D018426:SEER Program; D013405:Suicide / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Anxiety; Depression; Medicare; Prostate cancer; SEER