Risk of anxiety disorders in men with prostate cancer: a national cohort study

Men with prostate cancer (PC) may experience significant psychosocial distress from physical symptoms, treatment side effects, or fear of recurrence. However, little is known about the long-term risk of anxiety disorders in men with PC.

A national cohort study was conducted of 180 189 men diagnosed with PC during 1998-2017 and 1 801 890 age-matched population-based control men in Sweden. Anxiety disorders were ascertained from nationwide outpatient and inpatient records through 2018. Cox regression was used to estimate hazard ratios (HRs) while adjusting for sociodemographic factors and prior psychiatric disorders. Subanalyses explored differences by PC treatment during 2005-2017.

In 7.8 million person-years of follow-up, 94 387 (5%) men were diagnosed with anxiety disorders. Men with high-risk PC had a nearly 2-fold higher risk of anxiety disorders than control men without PC (adjusted HR = 1.96, 95% CI = 1.87 to 2.05). This risk was highest in the first 3 months after PC diagnosis (adjusted HR = 2.99, 95% CI = 2.49 to 3.59) but remained significantly elevated 10 or more years later (adjusted HR = 1.53, 95% CI = 1.35 to 1.74). Those treated only with androgen deprivation therapy (ADT) had the highest risk of anxiety disorders (adjusted HR = 2.08, 95% CI = 1.93 to 2.25). Men with low- or intermediate-risk PC had a modestly increased risk (adjusted HR = 1.39, 95% CI = 1.34 to 1.44).

In this large national cohort, men with PC had substantially increased risk of anxiety disorders, especially those with high-risk PC and treated only with ADT. Men with PC need close monitoring for timely detection and treatment of anxiety symptoms, particularly shortly after PC diagnosis.