Neuropsychiatric manifestations of prostate cancer and its treatment: Biological mechanisms and psycho-oncology perspectives

Table 1 Represents the summarization of the evidence of psychological and neurocognitive outcomes

Treatment modality	Psychological neuropsychiatric outcomes	Key findings	Quantitative estimates	Ref.
Active surveillance	Anxiety, depression	Most men show stable, low levels of psychological distress over time, although a minority experience clinically relevant symptom	Anxiety prevalence: Up to 23%-24%; depression prevalence: Approximately 12.5%	Watts et al[28], Alvisi et al[29], van den Bergh et al[30]
Radical prostatectomy	Mental distress, depression, anxiety	Persistent psychological distress may occur after surgery and is associated with urinary and sexual dysfunction and reduced quality of life	Approximately 8%-20% may require psychological support	Köhler et al[31], Ilie et al[32], Meissner et al[33], Mehnert et al[41]
Radiation therapy	Depression, anxiety	Psychological morbidity may be lower than with watchful waiting or ADT, although depression and anxiety remain clinically relevant	Not consistently reported across the cited studies	Ravi et al[34], Crump et al[35]
ADT	Depression, anxiety, cognitive impairment, reduced quality of life	ADT is associated with increased psychiatric and cognitive morbidity and reduced physical, social, and functional well-being	Depression: RR = 1.51; anxiety: HR = 2.08; cognitive impairment: RR = 1.45	Saini et al[36], Siebert et al[37], Galvão et al[38], Crump et al[39]
PCa- depression associated – healthcare burden	Depression-associated healthcare utilization	Comorbid depression is associated with substantially greater emergency care, hospitalization and mortality among men with PCa	ER visits: OR = 4.45; hospitalization: OR = 3.22; mortality: HR = 2.82	Jayadevappa et al[40]

Active surveillance and androgen deprivation therapy are the periods where anxiety and depression are most evident, though the majority of surveillance groups experience longitudinal stability while a delicate subgroup continues to suffer with persistent distress. Androgen deprivation therapy still stands as the strongest factor that predicts and leads to depression, anxiety, poor cognitive functioning and living with a low quality of life, the impact of which will be felt not only in the first year of treatment but also later on. Besides post-prostatectomy distress and radiation-related mood shifts that are considered additional factors contributing to the overall morbidity, the point about the necessity of integrative psycho-oncologic care is brought about more strongly. ADT: Androgen deprivation therapy; PCa: Prostate cancer; RR: Relative risk; HR: Hazard ratio; OR: Odds ratio; ER: Emergency room.