In the battle against prostate cancer, many advanced forms of hormonal therapies have been effective in regulating the disease progression and outcome. However, recent studies have suggested that these therapeutic pathways can double a man’s risk of falling into depression. These studies have shown that prostate cancer patients being treated with recent forms of hormonal agents or antagonists are twice more likely to develop depression later in life than those being treated with the older forms of hormone therapy or those that are not on any form of medications. According to an assistant professor of epidemiology at the University of Texas MD Anderson Cancer Center in Houston, Dr Kevin Nead, “this is a new risk that doctors should be aware of when prescribing these new hormonal drugs to patients with prostate cancer. Our study does not suggest that any men who are eligible for these medications should not be on them because of the risk of depression. What it does reinforce is that we have people who we know because they have cancer, are already at increased risk for depression.”
From their research, putting these patients on these medications has the potential of increasing the risks of falling into depression and this is associated with worse disease outcomes. Thus, such patients must be given full attention to and offered early intervention in treating their depression or preventing it. Prostate cancer depends basically on male sex hormones such as testosterone, which are known as androgens, where they derive nutrition and fuel for proliferation and survival. Doctors have long treated prostate cancer via the inhibitions of androgens which deprives the cancer cells of their nutrition. The mechanism of action of these agents has been effective in the treatment of prostate cancer. Other drugs which have also been introduced as second-generation anti-androgen drugs include Abiraterone and Apalutimide. Although inhibition of testosterone is very effective in the treatment of prostate cancer, researchers have suggested that a lack of the male sex hormone can increase the overall risk of depression.
Dr Nead added, “Men with low levels of testosterone are at risk of depression. Administration of testosterone in men with low levels of the hormone improves their mood and decreases the risk of depression. In general, cancer patients are at risk of depression owing to their struggle against the deadly disease. The risk tends to be profound with the decreasing amount of testosterone in the body. Depression on the other hand can affect the overall health of the patient, their response to treatment and also their healthcare-seeking behaviour. It has a major impact on their decision to pursing their cancer care and how often they get to see their doctor.
In other to fully understand the effect of these agents in increasing the risk of depression, the mechanism of action was studied. The older drugs act on bringing down the testosterone level only at the main production site, the testes. While other factories which may be involved in producing testosterone in smaller quantities such as the adrenal gland were spared. This low amount of testosterone produced by the adrenals helps to reduce the risk of depression in prostate cancer patients. The newer drugs which have been shown to affect all the androgenic receptors causes total depletion of the hormones thereby increasing the risk of depression.
In conclusion, simply because there’s an increased risk of depression with the use of newer drugs doesn’t warrant that we should entirely shy away from an otherwise very efficacious treatment but doctors prescribing such medications should take into cognizant of its long-term effects. Family members and friends of prostate cancer patients can help by watching their loved ones as they undergo hormone therapy for signs of depression.