Can anxiety and depression worsen recovery from surgery for prostate cancer?

This study examined whether anxiety and depression (AD) can worsen life quality after patients underwent radical prostatectomy (RP; removal of the prostate), as a treatment for prostate cancer. The authors found that patients with AD were more likely to experience urinary incontinence (UI; involuntary urine leakage) and poorer surgical outcomes after RP. 

A prostate cancer diagnosis can affect the quality of life of patients. These patients are likely to have AD and, in some cases, this can lead to higher suicide risk. One of the main treatments for prostate cancer is RP. Following this procedure, patients may experience UI, erectile dysfunction (ED), and a general decline in sexual function. These complications can have a role in the development of depression in patients that had the prostate removed.

However, few studies have tried to understand whether pre-existing AD can contribute to UI, ED, or other complications after surgery, such as infections.

5553 patients with prostate cancer undergoing RP were included in this study. All patients completed questionnaires to determine the existence and severity of AD. Patients were divided into groups based on the questionnaire, depending on whether they experienced normal, mild, or moderate-to-severe AD. The authors collected information about complications patients experienced after RP, up to 3 months after surgery.

Patients with moderate-to-severe AD had a 30% longer length of hospital stay and a 79% higher risk of complications after surgery compared to those with mild or no AD. More patients with no AD (21.5%) or mild AD (18%) had full control of the bladder after 1 week from surgery compared to those with moderate-to-severe AD (15.6%). Erectile function was not different among groups. However, patients with moderate-to-severe depression/anxiety had a higher use of phosphodiesterase type 5 (PDE) inhibitors and injections into the penis used for ED.

1 year after surgery, there was no difference in recurrence rates among groups.

This study showed that pre-existing depression and anxiety may worsen patients’ recovery after prostate removal surgery. The authors suggest that psychological assessment before surgery is important in patients with prostate cancer.

This study was based on medical records. Some information such as other medications taken at the time of surgery was missing. This might affect the results.

Discuss with your doctor if you are experiencing depression and anxiety.