Table 5.
Risk factors related to radiation therapy and androgen-deprivation therapy for mental illness among prostate cancer survivors, 2013-2017
| Patients, No. (%) | Mental illnessa |
Depressiona |
Mood disordera |
Anxietya |
||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HR | (95% CI) | HR | (95% CI) | HR | (95% CI) | HR | (95% CI) | |||||||||||
| Radiation typeb | ||||||||||||||||||
| External beam RT | 764 | (52.5) | (Referent) | (Referent) | (Referent) | (Referent) | ||||||||||||
| Brachytherapy | 462 | (31.8) | 0.77 | (0.63 | to | 0.94) | 1.68 | (0.46 | to | 6.15) | 0.67 | (0.47 | to | 0.95) | 0.84 | (0.57 | to | 1.24) |
| External beam RT + brachytherapy | 229 | (15.7) | 0.84 | (0.67 | to | 1.05) | NA | 0.76 | (0.52 | to | 1.13) | 0.71 | (0.44 | to | 1.14) | |||
| Radiation dose, Gy (categorical)c | ||||||||||||||||||
| 6.5-27.5 (incomplete RT regimen) | 365 | (25.1) | 1.34 | (1.09 | to | 1.64) | 3.14 | (0.84 | to | 11.74) | 1.38 | (0.99 | to | 1.92) | 1.226 | (0.85 | to | 1.78) |
| 27.6-80.9 | 608 | (41.8) | (Referent) | (Referent) | (Referent) | (Referent) | ||||||||||||
| 81.0-124.9 | 241 | (16.6) | 2.17 | (1.58 | to | 3.00) | 9.46 | (1.76 | to | 50.84) | 3.19 | (1.86 | to | 5.46) | 2.74 | (1.53 | to | 4.90) |
| ≥125.0 | 241 | (16.6) | 2.85 | (1.46 | to | 5.58) | 36.31 | (2.76 | to | 478.46) | 5.31 | (2.26 | to | 12.52) | 1.58 | (0.39 | to | 6.37) |
| P for trendd | .0004 | .1025 | <.0001 | .1837 | ||||||||||||||
| Radiation dose,c 10 Gy (continuous) | — | — | 1.00 | (1.00 | to | 1.01) | 1.09 | (0.97 | to | 1.23) | 1.00 | (0.99 | to | 1.01) | 1.00 | (0.99 | to | 1.01) |
| ADT typeb | ||||||||||||||||||
| Orchiectomy | 11 | (1.0) | 0.91 | (0.40 | to | 2.05) | NA | 1.29 | (0.41 | to | 4.10) | 0.98 | (0.24 | to | 4.04) | |||
| Medical castration | 1077 | (97.8) | (Referent) | — | (Referent) | (Referent) | ||||||||||||
| Surgical and medical castration | 13 | (1.2) | 0.77 | (0.36 | to | 1.64) | 2.04 | (0.26 | to | 15.91) | 0.91 | (0.29 | to | 2.89) | 0.88 | (0.22 | to | 3.60) |
| Medical castration | ||||||||||||||||||
| LHRH agonist/antagonist alone | 344 | (31.6) | (Referent) | (Referent) | (Referent) | (Referent) | ||||||||||||
| LHRH agonist/antagonist + antiandrogen | 370 | (33.9) | 1.21 | (0.98 | to | 1.49) | 1.73 | (0.62 | to | 4.79) | 1.35 | (0.95 | to | 1.91) | 1.05 | (0.70 | to | 1.58) |
| Antiandrogen alone | 278 | (25.5) | 1.30 | (1.03 | to | 1.63) | 1.39 | (0.38 | to | 5.06) | 1.22 | (0.82 | to | 1.81) | 1.18 | (0.77 | to | 1.82) |
| Abiraterone or enzalutamidee | 98 | (9.0) | 1.25 | (1.06 | to | 1.48) | 1.70 | (0.45 | to | 6.40) | 1.77 | (1.10 | to | 2.86) | 2.52 | (1.53 | to | 4.14) |
| ADT administrationf (metastatic prostate cancer only) | ||||||||||||||||||
| Intermittent | 41 | (22.0) | (Referent) | (Referent) | (Referent) | (Referent) | ||||||||||||
| Continuous | 145 | (78.0) | 1.94 | (1.11 | to | 3.38) | 1.83 | (0.34 | to | 9.93) | 0.96 | (0.45 | to | 2.05) | 1.14 | (0.49 | to | 2.62) |
| ADT duration,f mo (categorical) | ||||||||||||||||||
| 1-3 | 208 | (19.1) | 1.00 | (0.78 | to | 1.29) | 1.34 | (0.39 | to | 4.61) | 1.43 | (0.96 | to | 2.14) | 1.32 | (0.85 | to | 2.06) |
| 4-6 | 400 | (36.7) | (Referent) | (Referent) | (Referent) | (Referent) | ||||||||||||
| 7-17 | 242 | (22.2) | 1.13 | (0.89 | to | 1.42) | 1.11 | (0.30 | to | 4.04) | 1.22 | (0.81 | to | 1.84) | 1.25 | (0.80 | to | 1.95) |
| 18-28 | 118 | (10.8) | 0.99 | (0.74 | to | 1.34) | 3.55 | (1.16 | to | 10.89) | 1.49 | (0.94 | to | 2.36) | 1.41 | (0.84 | to | 2.39) |
| ≥29 | 122 | (11.2) | 1.15 | (0.87 | to | 1.51) | 0.45 | (0.11 | to | 1.93) | 1.34 | (0.86 | to | 2.09) | 1.33 | (0.79 | to | 2.23) |
| P for trend | .3844 | .6238 | .5509 | .5209 | ||||||||||||||
| ADT duration,f 6 mo (continuous) | — | — | 1.04 | (1.00 | to | 1.08) | 1.00 | (0.87 | to | 1.15) | 1.05 | (1.00 | to | 1.11) | 1.04 | (0.97 | to | 1.11) |
| P | .0348 | .9557 | .0610 | .2455 | ||||||||||||||
Bold values indicate statistical significance (P < .05). ADT = androgen-deprivation therapy; CI = confidence interval; HR = hazard ratio; LHRH = luteinizing hormone–releasing hormone; NA = not applicable; RT = radiation therapy.
Adjusted for race and ethnicity, baseline body mass index, baseline Charlson Comorbidity Index, risk group, age at diagnosis, and diagnosis year.
Adjusted for race and ethnicity, RT type, baseline body mass index, baseline Charlson Comorbidity Index, risk group, age at diagnosis, and diagnosis year.
P for trend was tested for trend and did not include the incomplete RT regimen category (6.5-27.5 Gy).
Including LHRH agonist/antagonist + abiraterone, orchiectomy + abiraterone, LHRH agonist/antagonist + enzalutamide, orchiectomy + enzalutamide, abiraterone alone, enzalutamide alone, and other complicated ADT combination.
Adjusted for race and ethnicity, ADT type, baseline body mass index, baseline Charlson Comorbidity Index, risk group, age at diagnosis, and diagnosis year.