Does treatment (Tx) for mental health illness (MHI) impact prostate cancer (PC) Tx and outcomes?
Authors: Klaassen Zachary , Janes Jessica L. , Parrish Joshua , McIntire Sydney , Sayyid Rashid K. , Machen Edward , De Hoedt Amanda Marie , Bergerot Cristiane Decat , Williams Stephen B. , Terris Martha K , Freedland Stephen J. 
Published: February 2025

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Background:
We previously showed that men with MHI are 20% less likely to be diagnosed with PC, but when diagnosed, are nearly 2x more likely to have aggressive PC compared to non-MHI men (ASCO 2023). Subsequently, we showed that men with MHI prior to PC Dx are more likely to receive definitive treatment (DTx) compared to non-MHI men with PC, however have poorer post-Tx surveillance adherence and increased risk of biochemical recurrence (BCR; ASCO 2024). However, among MHI men with PC, whether MHI treatment impacts PC treatment or outcomes has yet to be determined. The objective was to test the association between (i) MHI Tx and time from PC Dx to receipt of DTx, (ii) MHI Tx (prior to DTx end) and adherence to surveillance, and (iii) MHI Tx and time from DTx to BCR among treated men.
Methods:
This national, retrospective study used a cohort of males who were active users of the VA (≥2 encounters with a VA provider within a 5-yr period, 2000-2020) and diagnosed with MHI between the age of 40-80. Men were included if diagnosed with PC following MHI and had no prior malignancy. Competing risks models were used to test the association between MHI Tx (time-dependent covariate) and time from PC Dx to receipt of DTx (radical prostatectomy (RP) or radiotherapy (RT)). Logistic regression models were used to test the association between MHI Tx (prior to DTx end) and adherence to surveillance (≥3 PSAs within the first year following DTx, and at least 1 PSA in each year for the next 4 consecutive years) among treated men. Competing risks models were used to test the association between MHI Tx and time from DTx to BCR among treated men.
Results:
62,019 men diagnosed with PC and MHI (n=57,373 with MHI Tx) were included. MHI-treated men were more likely to receive DTx for PC than men without MHI-Tx in both univariable (HR: 1.11, 95% CI: 1.06-1.15) and multivariable (HR: 1.18, 95% CI: 1.13-1.23) analysis. Among men treated for PC (n=13,260), odds of adhering to surveillance did not differ between MHI-treated vs non-treated men in univariable (OR: 1.01, 95% CI: 0.92-1.11) or multivariable (OR: 1.03, 95% CI: 0.94-1.14) analysis. However, an interaction was present between MHI-Tx and year of Dx: MHI-treated men were more likely to adhere than non-treated men in earlier years (e.g., Dx 2001 – OR: 1.54, 95% CI: 1.22-1.94) but less likely in later years (e.g., Dx 2015 – OR: 0.85, 95% CI: 0.74-0.98). Risk of BCR was lower in MHI-treated vs. non-treated men in univariable (HR: 0.86, 95% CI: 80, 0.93) but not multivariable (HR: 0.95, 95% CI: 0.87-1.03) analysis.
Conclusions:
Men with PC who received treatment for MHI were more likely to receive DTx for their PC compared to men with PC and untreated MHI, however there was no difference in receipt of post DTx PSA surveillance among these groups. There was also no difference in risk of BCR in multivariable models. This suggests that treatment of MHI is important for receiving DTx for PC, but does not impact subsequent surveillance or BCR outcomes.