Embed mental health screening for prostate cancer diagnoses: Study

GP visits and antidepressant use are higher among men recently diagnosed with prostate cancer, a new Australian study reveals, prompting calls for mental health care to be part of routine care.
 
The University of South Australia-led study highlights the need for mental health screenings to be incorporated into routine prostate cancer diagnoses, after it found 15% of men began psychotropic medications directly after their diagnosis.
 
Rather than waiting for men to proactively seek out mental health supports once they’ve been diagnosed with prostate cancer, supports at the time of diagnosis and throughout treatment should be offered, the authors say.

Using population-based registry data linked with PBS and MBS data for all prostate cancer patients diagnosed in South Australia between 2012 and 2020, the study tracked the timing and scale of mental health issues among 13,693 men with prostate cancer.

While 15% commenced anti-anxiety and antidepression medications at the time of their diagnosis, only 6.4% sought help from mental health services for the first time.

The study authors note this small percentage of patients who seek mental health supports indicate ‘an acute need’ for ongoing care for all prostate cancer patients post-diagnosis.

‘Our study … shows that men are more likely to commence psychotropic medications than seek out mental health services,’ lead author Dr Tenaw Tiruye said.
 
‘But it also shows a significant gap, which is those men who have not sought help.’

Aside from non-melanoma skin cancers, prostate cancer is the most common cancer in Australia, with an estimated 24,000 diagnoses each year. 

Despite high survival rates, psychological issues are frequently reported among survivors, with up to 40% of these patients at risk of mental distress.

Dr Tiruye says the cancer can ‘take a serious toll’ on the mental health of men across diagnosis, surveillance, treatment, and follow‐up.

‘The rates of depression and anxiety among prostate cancer patients are significantly higher than those in the general population, as is the risk of suicide,’ he said.
 
The study found that psychotropic medication use rose from 34.5% five years before a prostate cancer diagnosis, to 40.3% five years after diagnosis, including an increase in use of antidepressants (20.7% to 26%).

Mental health service use increased from 10.2% to 12.1%, with the increase mostly being general practice mental health visits, rising from 7.8% to 10.6%.

Dr James Antoniadis is a GP, psychotherapist and Chair of RACGP Victoria’s GP and Psychiatry Liaison Committee. He told newsGP it’s a good idea to embed routine mental health screenings during diagnoses and follow-up, especially as men are less likely to seek care than women.

‘The near end-of-life, existential threats to aliveness, whether it’s a heart attack or prostate cancer or any other cancer, it does often trigger depression in men, because it’s their first real brush with mortality, the realisation their life is not infinite,’ he said.

‘But more than just prostate cancer, for any sort of condition likely to create an existential threat, men should be treated in the same way.

‘That should be to mind for any specialist seeing people, particularly men in these situations, and to have a sense of how they’re going to talk about it in a way that’s going to get past the man’s stoic defences, like “Oh I’m fine doc”, which quite often is just masking it.

Meanwhile, Bond University Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, told newsGP this ‘important study’ provides additional insights about the need for holistic care for men diagnosed with prostate cancer. 

‘Alongside identifying anxiety and depression, clinicians should be actively identifying suicidality … and there is an important role for the GP during cancer treatment and in cancer survivorship,’ he said. 

‘The risk of mental illness and distress associated with a diagnosis of prostate cancer needs to be considered when making a shared decision about whether to embark on a program of screening for prostate cancer. 

‘The RACGP calls for collaboration and coordination between the GP and specialist cancer treatment team so care for the patient is seamless, supportive and comprehensive.’

The college’s position statements on shared care models and cancer survivorship outline GPs’ role in this ongoing care, while the new 10th edition Red Book recommends that PSA be offered every two years for men who have been informed of the benefits and harms of screening. 

The UniSA research concludes that mental health outcomes of men with prostate cancer may be improved with early mental health screening, particularly during the diagnosis process, to enable early intervention.

Dr Antoniadis said having a strategy for identifying men who might be at risk of depression and/or suicide is important.

‘We know with any of those sorts of serious diagnoses where men just stoically hide away … it does tend to come to a head when they are presented with some sort of moral risk, even if they survive it and it’s not going to kill them,’ he said.

‘We know that prostate cancer doesn’t tend to cause the death of most people who get it … but depression and the collateral damage that happens around that is a bigger issue.’ 

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antidepressants cancer diagnosis cancer survivorship men’s health mental health prostate cancer