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

Table 2 Risk factors and predictors of psychological morbidity in prostate cancer

Risk factor	Psychological outcomes	Effect size/association	Statistical significance	Ref.
Divorced relationship status	Anxiety	Higher prevalence of clinically relevant anxiety among divorced men (56.3%) compared with the overall cohort (23.1%)	P = 0.011	Watts et al[28]
High-risk PCa	Depression, anxiety	Major depression: AHR = 1.82 (95%CI: 1.75-1.89); anxiety disorders: AHR = 1.96 (95%CI: 1.87-2.05)	P < 0.001	Crump et al[35], Crump et al[39]
ADT	Depression, anxiety, cognitive impairment	Depression: RR = 1.51; anxiety: AHR = 2.08 (95%CI: 1.93-2.25); cognitive impairment/dementia: RR = 1.45	Depression: P = 0.0002; anxiety: P < 0.001; cognitive impairment: P = 0.024	Siebert et al[37], Crump et al[39]
Younger age (per 10-year decrease)	Depression	OR = 1.38 (95%CI: 1.16-1.60)	P = 0.001	Fervaha et al[48]
Poor social support/absence of caregiver	Anxiety, depression	Absence of caregiver: OR = 5.02; emotional support: OR = 0.81; instrumental support: OR = 0.67	P < 0.05	Mehnert et al[41], Morris et al[49]
Moderate-to-severe urinary dysfunction	Mental distress	OR = 4.79 (95%CI: 1.04-22.03)	P < 0.05	Ilie et al[32]
Poor relationship satisfaction/sexual difficulties	Psychological distress	Lower relationship satisfaction associated with greater distress; OR = 0.14 (95%CI: 0.03-0.77)	P < 0.05	Köhler et al[31], Ilie et al[32]
Pre-existing depression or anxiety	Depression	OR = 3.64 (95%CI: 2.42-5.48)	P < 0.0001	Fervaha et al[48]
High-risk disease classification	Depression	OR = 1.49 (95%CI: 1.05-2.12)	P = 0.027	Fervaha et al[48]
Poor performance status (ECOG > 1)	Depression	OR = 5.01 (95%CI: 3.49-7.20)	P < 0.0001	Fervaha et al[48]
Cancer-related/treatment-related fatigue	Psychological burden, Reduced quality of life	Fatigue prevalence: 42% with ADT, 21% after radical prostatectomy, 40% after radiotherapy	Reported with 95%CIs	Luo et al[50]

It provides a brief summary of the demographic, clinical, treatment-related and psychosocial factors associated with depression, anxiety, mental distress, cognitive impairment, and poor quality of life. The strongest predictors were high-risk disease, androgen deprivation therapy, younger age, poor social support, urinary and relationship problems, pre-existing depression and anxiety, poor performance status and treatment-related fatigue. The literature reports varying levels of association from modest to strong (e.g., odds ratio up to 5.02, adjusted hazard ratio up to 2.08). ADT: Androgen deprivation therapy; PCa: Prostate cancer; aHR: Adjusted hazard ratio; RR: Relative risk; OR: Odds ratio; ECOG: Eastern Cooperative Oncology Group.