These days more men are surviving prostate cancer, and they are living for longer after diagnosis than in previous decades. But survival rates do not tell the whole story. Living longer is not the same as living well. New Australian research has shown that men with prostate cancer are at higher risk of suicide than their counterparts who don't have the disease. The psychological needs of all men with prostate cancer require consideration and access to support as an important part of disease management.
There are over 200,000 Australian men who have been diagnosed with prostate cancer. Although the average survival rate is relatively good (95% survival for >5 years), this leaves many thousands of men who are continuing their fight against this disease and/or coping with the side effects of treatment. Men with prostate cancer report considerable psychological impact on their lives, such as distress, worry, anxiety and sadness.
Suicide and self-harm are significant problems in Australia. We know that about 2,000 Australians die by suicide each year. In 2015, approximately 2.5% of deaths were caused by suicide. Men are more likely to die by suicide than women, and men above the age of 75 are at relatively high risk (shown in the graph below). The pressure of living with prostate cancer is therefore imposed upon people who are already at a higher than average risk of suicide.
A new study on the risk of suicide in men with prostate cancer was published last month. The first author is A/Prof David Smith from Cancer Council NSW and the University of NSW. Prof Suzanne Chambers (Griffith University) and Prof Dianne O'Connell (Cancer Council NSW and University of NSW) also contributed to this project.
This Australian study asked whether men with prostate cancer were at higher risk of suicide than the same aged men without the disease. The researchers also asked which groups of men were most at risk. To ask these questions, they obtained data from the NSW Cancer Registry for men diagnosed with prostate cancer from 1997 to 2007. Their cause of death was cross-referenced by linked reports from the NSW Registry of Births, Deaths and Marriages.
Results from this study showed that 51,924 men were diagnosed with prostate cancer in NSW between 1997 and 2007. 11,236 of these men had died by December 2007. 49 of these deaths were classified as suicide. The study showed that:
- The rate of suicide for NSW men with prostate cancer was 1.7-fold higher than for men in the equivalent age group who do not have prostate cancer. This means that men with prostate cancer have almost double the risk of suicide than men of the same age without the disease.
- Men with advanced prostate cancer had 2.68 times higher risk of suicide than men with localised prostate cancer.
- Men living outside major cities had a lower risk of suicide. They were less than half as likely to die by suicide than men living in major cities.
- Single, divorced, widowed or separated men with prostate cancer were 4.18 times more likely to commit suicide than married men with the disease.
- The risk of suicide was highest for men within the first year after diagnosis.
This study has shown that a diagnosis with prostate cancer increases the chance that a man will die by suicide. Men with prostate cancer were at higher risk in the first 12 months after diagnosis, or if they had advanced disease, lived in the city or were unmarried. The results of this Australian study are consistent with similar research from the US and Sweden.
The study authors consider hormonal therapy (androgen deprivation therapy (ADT)) to be a possible risk factor for suicide. ADT has many side effects that reduce quality-of-life. These include increased fatigue, decreased physical activity, greater emotional distress and poorer general health. Men with advanced prostate cancer, who were more likely to take ADT, were at higher risk of suicide in the Australian study.
Overall, the number of men with prostate cancer who die by suicide is low, even though it is higher than for men without the disease. But recording the number of men who die by suicide is probably only the tip of the iceberg in terms of understanding the psychological toll this disease takes. It's estimated that for every person who dies by suicide, 20 more will have also attempted suicide. It's clear that there are many men diagnosed with prostate cancer who need more support, particular in the first year after their diagnosis.
The authors of the Australian study recommend offering additional psychological support for men diagnosed with prostate cancer if they are considered to be at higher risk of distress or suicide. The men who are considered vulnerable may be those suffering from isolation/loneliness, pre-existing depression or previous suicidal behaviour. It's believed that early identification of men at higher risk of distress or suicide would help in reducing this risk. A simple method to detect distress for these men has been developed and validated by Prof Suzanne Chambers' research group. This "Distress Thermometer" is a simple, no cost survey that can be delivered to newly-diagnosed men by health professionals such as GPs, Specialists or Prostate Cancer Specialist Nurses. It has been developed specifically for men with prostate cancer. Similar types of surveys are used in other situations to indicate people who are at greater risk of distress, such as for detecting depression in new mothers. Aside from funding the creation of the distress thermometer, PCFA has also developed ProsCare. This is a psychological care model that acts as a guide for health professionals delivering psychological care for men affected by prostate cancer.
Men with prostate cancer and their families, friends and carers who have concerns about their ability to cope may be able to find help from these sources:
A trained mental health professional such as a psychologist or social worker. Contact your local GP for assessment and referral to access Medicare bulk billed sessions through a mental health care plan.
Lifeline Australia 13 11 14
Beyondblue 1300 224 636, www.beyondblue.org.au
Cancer Council Helpline 13 11 20
Carer crisis telephone counselling (after hours) 1800 059 059
QLine 1800 184 527 or www.qlife.org.au, or contact your local gay and lesbian health network
