Association of androgen deprivation therapy and depression in the treatment of prostate cancer: A systematic review and meta-analysis

Kevin T. Nead, Sumi Sinha, David D. Yang, Paul L. Nguyen

Research output: Contribution to journalArticlepeer-review

69 Scopus citations

Abstract

Background There is increasing evidence that androgen deprivation therapy (ADT) may be associated with depression. Existing studies have shown conflicting results. Methods PubMed, Web of Science, Embase, and PsycINFO were queried on April 5, 2017. Eligible studies were in English and reported depression among individuals with prostate cancer exposed to a course of ADT vs. a lesser-exposed group (e.g., any-ADT vs. no ADT and continuous ADT vs. intermittent ADT). We used the MOOSE statement guidelines and the Cochrane Review Group's data extraction template. Study quality was evaluated by Newcastle-Ottawa Scale criteria. We conducted a random-effects meta-analysis to calculate summary statistic risk ratios (RRs) and 95% CIs. Heterogeneity was quantified using the I2 statistic and prespecified subgroup analysis. Small study effects were evaluated using Begg and Egger statistics. Results A total of 1,128 studies were initially identified and evaluated. A meta-analysis of 18 studies among 168,756 individuals found that ADT use conferred a 41% increased risk of depression (RR = 1.41; 95% CI: 1.18–1.70; P<0.001). We found a consistent strong statistically significant association when limiting our analysis to studies in localized disease (RR = 1.85; 95% CI: 1.20–2.85; P = 0.005) and those using a clinical diagnosis of depression (RR = 1.19; 95% CI: 1.08–1.32; P = 0.001). We did not find an association for continuous ADT with depression risk compared to intermittent ADT (RR = 1.00; 95% CI: 0.50–1.99; P = 0.992). There was no statistically significant evidence of small study effects. Statistically significant heterogeneity in the full analysis (I2 = 80%; 95% CI: 69–87; P<0.001) resolved when examining studies using a clinical diagnosis of depression (I2 = 16%; 95% CI: 0–60; P = 0.310). Conclusion The currently available evidence suggests that ADT in the treatment of prostate cancer is associated with an increased risk of depression.

Original languageEnglish (US)
Pages (from-to)664.e1-664.e9
JournalUrologic Oncology: Seminars and Original Investigations
Volume35
Issue number11
DOIs
StatePublished - Nov 2017
Externally publishedYes

Keywords

  • Androgen deprivation therapy
  • Behavioral symptoms
  • Depression
  • Hormone therapy
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

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