The Clinical Impact of Depression and Anxiety on Complications After Prostate Cancer Treatment: A Retrospective Cohort Study

Purpose: This large retrospective study aims to better understand the relationship of depression and anxiety with posttreatment complications in prostate cancer patients, specifically erectile dysfunction (ED) and urinary incontinence.Materials and Methods: We retrospectively reviewed prostate cancer patients diagnosed between 2016–2021. Patient Health Questionnaire-9 scores were obtained to measure anxiety and depression before undergoing prostate cancer treatment. We examined the presence and severity of ED and urinary incontinence at posttreatment intervals. Our primary outcome was the association between pretreatment anxiety and depression with an increased incidence of posttreatment ED and urinary incontinence.Results: In total, 489 patients treated for prostate cancer were included in this study. At baseline, 92% of patients had minimal or mild depression, while 8% experienced moderate to severe depression. Posttreatment complications were evaluated at the first posttreatment visit and during 6-month and 12-month follow-ups. ED was observed in 66%, 65%, and 61% of patients at these respective time points. Urinary incontinence was reported in 35%, 26%, and 19% of patients at these posttreatment time points, respectively. No significant associations were found between anxiety and incontinence or ED. However, at all posttreatment time points, patients with moderate to severe depression compared to minimal or mild depression had a greater prevalence of incontinence (p=0.026, p=0.049, and p=0.019 respectively). There was a trend toward increased severity of incontinence, as measured by urinary pad usage, in patients with moderate to severe depression compared to patients with minimal or mild depression.Conclusion: The relationship between depression and prostate cancer is established, but this study is the first of its kind to demonstrate the significant association of moderate to severe depression with posttreatment incontinence. These findings underscore the need for integrating mental health considerations into the comprehensive care of prostate cancer patients, with the goal of reducing posttreatment complications.