title: Suicide and accidental deaths among patients with non-metastatic prostate cancer.
abstract: OBJECTIVE
  To determine if American men with prostate cancer are at increased risk of suicide/accidental death compared with other cancers and if the receipt of definitive treatment alters this association, as patients with cancer are at increased risk of suicide and evidence suggests a relationship between suicides and deaths due to accidents and externally caused injuries.
  
  
  METHODS
  Demographic, socio-economic and tumour characteristics of men with prostate cancer and men with other solid malignancies were extracted from the Surveillance, Epidemiology and End Results (SEER) database (1988-2010). Poisson regression models were fitted to compare the incidence of suicidal and accidental deaths in prostate cancer vs other solid cancers. Multivariate Cox regression was used to determine if receipt of definitive primary treatment impacted the risk of suicide or accidental death in men with localised/regional prostate cancer.
  
  
  RESULTS
  Risk of suicidal and accidental death was significantly lower in men with prostate cancer (1 165 [0.2%] and 3 199 [0.6%]) than men with other cancers (2 232 [0.2%] and 4 501 [0.5%], respectively), except within the first year of diagnosis (adjusted relative risk [ARR] 3.98, 95% confidence interval [CI] 3.02-5.23 and ARR 4.22, 95% CI 3.24-5.51, respectively, 0-3 months after diagnosis). Men with non-metastatic prostate cancer who were White, uninsured, or recommended but did not receive treatment (hazard ratio vs treated 1.44, 95% CI 1.20-1.72, and 1.44, 95% CI 1.30-1.59, both P < 0.001) were at increased risk of suicidal and accidental mortality, respectively. Absence of data about previous co-morbidities and drug addictions in the SEER dataset was an important limitation.
  
  
  CONCLUSIONS
  Relative to other cancers, men with prostate cancer were at increased risk of suicide and accidental deaths within the first year of diagnosis and when definitive treatment was recommended but not received, suggesting the need for close monitoring and coordination with mental health professionals in at-risk men with potentially curable disease.
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.|VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Deepansh
authors: D
authors: Dalela
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Nandita
authors: N
authors: Krishna
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: James
authors: J
authors: Okwara
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Mark A
authors: MA
authors: Preston
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Firas
authors: F
authors: Abdollah
authors: Department of Medical Oncology, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Toni K
authors: TK
authors: Choueiri
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Gally
authors: G
authors: Reznor
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Jesse D
authors: JD
authors: Sammon
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Marianne
authors: M
authors: Schmid
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Adam S
authors: AS
authors: Kibel
authors: Department of Radiation Oncology, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Paul L
authors: PL
authors: Nguyen
authors: VUI Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors: Mani
authors: M
authors: Menon
authors: Division of Urologic Surgery and Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Quoc-Dien
authors: QD
authors: Trinh
mesh_terms: D000059:Accidents / Q000401:mortality*; D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality*; D018570:Risk Assessment; D013405:Suicide / Q000706:statistics & numerical data*
keywords: SEER; accidental death; primary treatment; prostate cancer; suicide