Prostate Cancer Diagnosis May Bring Suicide, Heart Risks

Prostate cancer may not be as deadly as it once was, likely because of advances in screening and treatment, but a new study suggests that even a diagnosis of the disease carries some risks.

A collaboration including researchers from Harvard University and the Karolinska Institute in Sweden looked at data for more than 4 million men in Sweden above the age of 30 and found that the diagnosis of prostate cancer -- something that occurred in over 160,000 of those men -- increased the relative risks for fatal heart problems 11 times and suicide by eight times in the week after diagnosis.

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"Stress can be an important trigger for physiologic reactions, including increased risk of cardiovascular disease," said Dr. Meir Stampfer, professor of nutrition and epidemiology at the Harvard School of Public Health. "The diagnosis of cancer also can cause high enough stress to see a noticeable increase in both heart disease and suicide."

Given that suicide is generally rare, the study does not suggest that men commit it in great numbers following a prostate cancer diagnosis, but doctors say it does suggest a need for more careful monitoring and communication with patients following a diagnosis.

"This study is certainly a wakeup call that there are other issues…that somebody could be at increased cardiovascular risk or increased suicide risk," said Bruce Trock, an epidemiologist in the department of urology at Johns Hopkins. "The lesson [of the study] is more for physicians, that when they give out a diagnosis of prostate cancer, they should be thinking about this.

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"It would be incumbent for a physician to try to keep tabs on what's going on with this patient," especially during the first month, he said. "Once somebody's diagnosed with prostate cancer, usually the first month is when they're trying to make up their mind about treatment."

But possible heart disease and suicidal thoughts are not the only potential problems for men after a prostate cancer diagnosis.

Bruce MacDonald, a social worker at Dana-Farber Cancer Institute in Boston, counsels men following a prostate cancer diagnosis. While he said in his eight years there he has only had one patient who attempted suicide, he far more frequently deals with patients who are depressed or have other problems following treatment.

Among men who have removal of the prostate, some men are left impotent permanently, while others have to deal with incontinence. He said others must take hormonal treatments when surgery fails to remove the tumor completely from the prostate, and the absence of testosterone can lead to impotence and a lack of libido.

MacDonald said a man who is 50 years old and is diagnosed with prostate cancer, then left without a libido by the surgery can be heavily affected by the change in sexual function.

"That, obviously, is a red flag when it comes to what can lead to depression," he said. "It's a real struggle for a man in terms of his self-image, which sometimes can change really overnight. If there is significant clinical depression, we do our best to help a man receive treatment for that."

MacDonald explained that those treatments could include medication and psychotherapy, and possibly couples therapy to deal with the changing relationship with a partner.

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