Citation

Carlsson S, Sandin F, Fall K, Lambe M, Adolfsson J, Stattin P, Bill-Axelson A. Eur. J. Cancer 2013; 49(7): 1588-1599.

Affiliation

Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Urology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. Electronic address: carlssos@mskcc.org.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.ejca.2012.12.018

PMID

23337463

Abstract

PURPOSE: Risk of suicide is increased among men with prostate cancer. We investigated this association among men with low-risk cancer, usually detected by prostate specific antigen (PSA)-testing. PATIENTS AND METHODS: Relative risk (RR) of suicide was calculated by use of Poisson regression analysis within the Prostate Cancer data Base Sweden (PCBaSe) 2.0, a nation-wide, population-based database, comparing 105,736 men diagnosed with prostate cancer between 1997-2009 to 528,658 matched prostate cancer-free men. RESULTS: During the first 6months after diagnosis, there were 38 suicides among men with prostate cancer; incidence rate 0.73 per 1000 person-years (PY) and 30 suicides in the comparison cohort; 0.11 per 1000PY, corresponding to a RR of suicide of 6.5 (95% confidence interval (CI) 4.0-10). Risk was highest among men with distant metastases, incidence rate 1.25 per 1000PY, RR 10 (95% CI 5.1-21) but risk was also increased for men with low-risk tumours, incidence rate difference 0.45 per 1000PY and RR 5.2 (95% CI 2.3-12) and across categories of socioeconomic status and comorbidity. Eighteen months after diagnosis, risk of suicide had decreased to 0.27 per 1000PY, RR 1.0 (95% CI 0.68-1.5) for low-risk prostate cancer but remained increased among men with metastases, 0.57 per 1000PY, RR 1.8 (95% CI 1.1-2.9). CONCLUSION: Although the increase in absolute risk of suicide was modest, our findings reflect the severe psychological stress that prostate cancer patients may experience after diagnosis. The increased risk of suicide observed in men with prostate cancer, including low-risk, calls for increased awareness.

Language: en