Prostate cancer diagnosis raises suicide risk

The shock of a prostate cancer diagnosis is enough to push some men over the edge, particularly if they don't have a partner's support

Men with prostate cancer are 70% more likely to take their own lives than those in the general population, with the risk of suicide peaking in the first year after diagnosis.

Over the past decade, around 51,000 men have been diagnosed with prostate cancer in NSW. Of these, 49 committed suicide, according to a study by Cancer Council NSW. 

The common threads in most deaths by suicide were loneliness and social isolation, combined with a poor prognosis. The risk of suicide was 2.7 times greater in patients whose disease had spread, and more than four times higher in patients who were widowed, divorced, separated or single. 

Living in a major city also elevated the risk of suicide, which was probably because urban centres were lonelier spaces compared with smaller towns, the researchers said. 

Men diagnosed with prostate cancer who had pre-existing depression or suicidal ideation needed to be offered psychological support, the Cancer Council NSW said.

A “brief, simple, no cost” Distress Thermometer for prostate cancer patients (http://bit.ly/2ushRF1) could be used by GPs to identify potentially vulnerable patients, the researchers said. 

The tool asks patients to rate their level of mental distress on a scale from one to 10. It also lists potential problems that could be causing distress and asks men to put a tick next to which ones they are experiencing. 

“When GPs see men in the post-diagnosis or treatment period this could be a time when discussion comes up about how men are travelling,” Associate Professor David Smith, the first author on the paper and an epidemiologist at Cancer Council NSW, said.

“Obviously, many men do cope well and that’s great, but there are men falling through the gaps who really could benefit from this.”

The findings of the study were only the “tip of the iceberg” in the spectrum of mental anguish associated with a prostate cancer diagnosis, he said.

“We do know that a proportion of men exhibit a considerable degree of stoicism, which in these circumstances probably doesn’t enhance their health, and so opening up and talking not just about the functional issues surrounding prostate cancer but also about the mental health issues is really important.”

Associate Professor Smith has seen the devastating effect of suicide through his research. “Several men in the study that I’ve been running for a long period of time have experienced suicidal ideation and at least two of them have gone through with it,” he said. 

“And the effect that has on our community and the people around them is considerable.”

PLOS ONE 2018, June 13