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. 2023 Oct 23;116(3):445–454. doi: 10.1093/jnci/djad175

Table 4.

Clinical risk factors for mental illness among prostate cancer survivors

0-2 y After cancer diagnosis
 2-5 y After cancer diagnosis
 5-10 y After cancer diagnosis
 10- y After cancer diagnosis
Mental illnessa
 Mental illnessa
 Mental illnessa
 Mental illnessa
Factor HR (95% CI) HR (95% CI) HR (95% CI) HR (95% CI)
Diagnosis yearb
 2004-2008 (Referent) (Referent) (Referent) (Referent)
 2009-2012 1.08 (1.02 to 1.16) 1.09 (1.01 to 1.17) 1.23 (1.16 to 1.31) 3.18 (2.69 to 3.76)
 2013-2017 1.21 (1.13 to 1.29) 1.53 (1.42 to 1.64) 2.36 (2.11 to 2.63) —
Age at diagnosis,d y
 <50 1.18 (0.99 to 1.40) 1.01 (0.83 to 1.23) 0.84 (0.69 to 1.02) 0.58 (0.42 to 0.79)
 50-59 1.08 (1.01 to 1.16) 0.91 (0.84 to 0.99) 0.82 (0.76 to 0.89) 0.85 (0.76 to 0.95)
 60-69 (Referent) (Referent) (Referent) (Referent)
 70-79 0.91 (0.85 to 0.97) 1.16 (1.08 to 1.24) 1.17 (1.09 to 1.26) 1.21 (1.09 to 1.34)
 ≥80 0.96 (0.87 to 1.07) 1.37 (1.22 to 1.53) 1.36 (1.19 to 1.55) 1.01 (0.76 to 1.34)
PSA, ng/mLb
 <4.0 (Referent) (Referent) (Referent) (Referent)
 4.0-6.9 0.91 (0.84 to 1.00) 1.02 (0.95 to 1.09) 0.94 (0.86 to 1.03) 0.94 (0.82 to 1.07)
 7.0-10.0 0.94 (0.85 to 1.03) 1.11 (1.02 to 1.22) 0.95 (0.85 to 1.05) 0.84 (0.72 to 0.98)
 10.1-20.0 0.98 (0.88 to 1.08) 1.18 (1.06 to 1.32) 0.94 (0.84 to 1.05) 0.83 (0.70 to 0.98)
 >20.0 1.26 (1.13 to 1.40) 1.39 (1.24 to 1.56) 1.15 (1.01 to 1.32) 1.02 (0.81 to 1.27)
Gleason Grade Groupb
 3 + 3 or less (Referent) (Referent) (Referent) (Referent)
 3 + 4 1.17 (1.09 to 1.25) 1.02 (0.95 to 1.09) 1.08 (1.01 to 1.16) 0.99 (0.90 to 1.10)
 4 + 3 1.29 (1.18 to 1.40) 1.11 (1.02 to 1.22) 1.09 (0.99 to 1.20) 1.09 (0.93 to 1.27)
 4 + 4 1.31 (1.19 to 1.45) 1.18 (1.06 to 1.32) 1.09 (0.97 to 1.23) 1.08 (0.88 to 1.33)
 9 or 10 1.55 (1.41 to 1.71) 1.39 (1.24 to 1.56) 1.30 (1.13 to 1.49) 0.84 (0.63 to 1.12)
Modified risk groupb
 Very low (Referent) (Referent) (Referent) (Referent)
 Low 1.10 (0.98 to 1.23) 1.12 (1.00 to 1.26) 1.01 (0.91 to 1.13) 1.05 (0.89 to 1.23)
 Favorable intermediate 1.23 (1.11 to 1.36) 1.07 (0.96 to 1.19) 1.04 (0.94 to 1.15) 1.13 (0.97 to 1.31)
 Unfavorable intermediate 1.33 (1.19 to 1.48) 1.07 (0.95 to 1.20) 1.00 (0.90 to 1.12) 1.04 (0.88 to 1.23)
 High 1.46 (1.31 to 1.64) 1.30 (1.15 to 1.46) 1.09 (0.97 to 1.23) 0.95 (0.79 to 1.15)
 Very high 1.68 (1.50 to 1.87) 1.37 (1.22 to 1.55) 1.17 (1.03 to 1.32) 0.93 (0.75 to 1.16)
American Joint Committee on Cancer staginge
 I (Referent) (Referent) (Referent) (Referent)
 II 1.21 (1.13 to 1.29) 1.01 (0.94 to 1.08) 1.02 (0.95 to 1.09) 1.06 (0.97 to 1.17)
 III 1.40 (1.29 to 1.52) 1.16 (1.06 to 1.27) 1.07 (0.97 to 1.17) 0.87 (0.75 to 1.01)
 IV 2.04 (1.82 to 2.29) 1.90 (1.66 to 2.19) 1.74 (1.45 to 2.08) 1.15 (0.79 to 1.67)
First course of treatmentf
 Surgery only (Referent) (Referent) (Referent) (Referent)
 Radiation only 0.82 (0.76 to 0.89) 0.98 (0.89 to 1.07) 1.04 (0.95 to 1.13) 0.93 (0.81 to 1.06)
 Hormone only 0.90 (0.79 to 1.03) 1.51 (1.31 to 1.74) 1.48 (1.25 to 1.75) 0.80 (0.54 to 1.19)
 Surgery + radiation 0.97 (0.76 to 1.24) 1.20 (0.92 to 1.56) 1.13 (0.84 to 1.51) 0.84 (0.54 to 1.30)
 Surgery + hormone 1.09 (0.90 to 1.31) 1.15 (0.91 to 1.45) 1.12 (0.88 to 1.43) 1.28 (0.91 to 1.80)
 Radiation + hormone 0.82 (0.75 to 0.91) 0.99 (0.89 to 1.11) 1.04 (0.93 to 1.15) 0.99 (0.85 to 1.17)
 Chemotherapy + Otherg 0.95 (0.79 to 1.13) 1.39 (1.12 to 1.71) 1.33 (1.03 to 1.71) 0.91 (0.57 to 1.47)
 Conservative treatment 0.69 (0.63 to 0.75) 1.19 (1.09 to 1.30) 1.17 (1.07 to 1.28) 1.08 (0.93 to 1.24)
Quality of life side effecth
 Sexual dysfunctioni — — — — 1.32 (1.25 to 1.39) — — — — — — — —
 Urinary dysfunction — — — — 1.54 (1.47 to 1.60) — — — — — — — —
 Bowel dysfunction — — — — 1.46 (1.37 to 1.55) — — — — — — — —
 None — (Referent) — —
a

Bold values indicate statistical significance (P < .05). CI = confidence interval; HR = hazard ratio.

b

Adjusted for race and ethnicity and diagnosis age.

c

Adjusted for baseline body mass index and baseline Charlson Comorbidity Index.

d

Adjusted for race and ethnicity and American Joint Committee on Cancer staging.

e

Adjusted for race and ethnicity, baseline body mass index, diagnosis year, age at diagnosis, and education.

f

Adjusted for race and ethnicity, baseline body mass index, baseline Charlson Comorbidity Index, risk group, age at diagnosis, and education.

g

Other included surgery + radiation + chemotherapy, surgery + chemotherapy, radiation therapy + chemotherapy, and radiation therapy + androgen-deprivation therapy + chemotherapy.

h

The evaluation of quality of life side effects was conducted for the entire follow-up period, considering their enduring and recurring characteristics. Adjusted for race and ethnicity, first course of treatment, baseline body mass index, baseline Charlson Comorbidity Index, risk group, age at diagnosis, and education.

i

Sexual bothersomeness is excluded in sexual dysfunction because of the overlapping issue with mental illness.