Do men with early prostate cancer commit suicide more frequently?

The introduction of prostate-specific antigen (PSA) testing as a screening tool for early detection of prostate cancer (PCa) in the beginning of the 1990s drastically increased the detection of PCa. The risk of suicide is increased among cancer patients including men with PCa. To assess the risk of suicide among men diagnosed with PCa subsequent to PSA testing, a nation-wide study was carried out in Sweden. The results are published in the March issue of European Urology, the scientific journal of the European Association of Urology (EAU).

Anxiety related to a crisis reaction may develop into a depression, and several studies have shown that there is a high anxiety level among screeners in various screening programs. However, as in most countries, men who underwent PSA testing in Sweden at the time represent an opportunistic screening population and not a true population-based screening program by invitation. Therefore, they may have been more health conscious, less prone to develop depression, and more prepared to accept the potential side effects of curative treatment than the general population.

The number of suicides registered for cases in the Prostate Cancer Base Sweden (a database in which a number of different registers are merged) cohort was compared with the expected number of suicides in an age-matched general male Swedish population. The strengths of this study include the population-based design with inclusion of approximately 98% of all men in Sweden diagnosed with PCa between1997 and 2006.

There was no evidence for an increased risk of suicide among men diagnosed with early nonpalpable PCa detected by PSA testing. The suicide rate, however, was twice as high among men diagnosed with locally advanced or metastatic disease compared with the general male population. This is important to acknowledge in order to focus on the need to identify signs of depression and optimise treatment among this category of patients.