Immediate risk of suicide and cardiovascular death after a prostate cancer diagnosis

To study the risks men diagnosed with prostate cancer in the United States face, Fang Fang, M.D., of the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, in Boston, and colleagues used data from over 340,000 prostate cancer patients listed in the Surveillance, Epidemiology, and End Results database between 1979 and 2004 and from the general population. The researchers compared risks in the first year and months after diagnosis.

According to the study, 148 men died of suicide (mortality rate= 0.5 per 1,000 person-years) and 6,845 died of cardiovascular diseases (mortality rate = 21.8 per 1000 person-years). Increased risk of suicide was found during the first year, in particular the first 3 months. The risk of cardiovascular death was slightly elevated during the first year, especially in the first month and particularly among those with metastatic disease.

According to the study, the elevated suicide risk was apparent before prostate-specific antigen (PSA) testing was common (1979-1986) and when it was first introduced (1987-1992), but not since PSA testing has been widespread (1993-2004). The authors say this observation is most likely due to the potentially lower degree of stress associated with the diagnosis of indolent prostate cancer.

"We believe that suicide and cardiovascular death reflect only the tip of the iceberg of anxiety, mood disturbance, and perhaps other mental illness (or suffering) after a prostate cancer diagnosis," the authors write. "Hence, our study suggests the potential importance of providing emotional counseling and support for patients newly diagnosed with cancer. It also adds to the increasingly complex scenario of pros and cons of extensive PSA testing, which entails detection of large numbers of nonlethal prostate cancers."