Association between androgen deprivation therapy and anxiety among 78 000 patients with localized prostate cancer

ObjectivesTo examine whether any androgen deprivation therapy use or longer duration is associated with an increased risk of anxiety in patients with prostate cancer. MethodsWe identified 78 552 men aged 66 years with stage I-III prostate cancer using the Surveillance, Epidemiology, and End Results-Medicare linked database from 1992 to 2006, excluding patients with psychiatric diagnoses within the year prior or 6 months after prostate cancer diagnosis. Multivariable Cox regression was used to examine the association between pharmacological androgen deprivation therapy and diagnosis of anxiety. ResultsThe 43.1% (33 882) of patients who received androgen deprivation therapy experienced a higher 3-year cumulative incidence of anxiety compared with men who did not (4.1% vs 3.5%, P < 0.001). Any androgen deprivation therapy use was associated with a nearly significant increased risk of anxiety (adjusted hazard ratio 1.08, 95% confidence interval 1.00-1.17, P = 0.054). There was a significant trend between a longer duration of therapy and increased risk of anxiety (P-trend = 0.012), with a 16% higher risk for 12 months (adjusted hazard ratio 1.16, 95% confidence interval 1.04-1.29, P = 0.010). ConclusionsAndrogen deprivation therapy was associated with an elevated risk of anxiety in this cohort of elderly men with localized prostate cancer, with the risk higher with a longer duration of treatment. Anxiety should be considered among the possible psychiatric effects of androgen deprivation therapy and discussed before initiating treatment, particularly if a long course is anticipated.