前列腺癌患者使用抗荷爾蒙藥物與憂鬱症狀關係
陳一中1、林文榮1、陳建志1、江百凱1、邱文祥1,2、蔡維恭1
馬偕紀念醫院 泌尿科1；馬偕醫學院；陽明醫學院2
The relationship between androgen deprivation therapy and depression symptoms in patients with prostate cancer
Yi-Zhong Chen1, Wun-Rong Lin 1, Marcelo Chen1, Pai-Kai Chiang 1, Allen W. Chiu1, 2, Wei-Kung Tsai1
Department of Urology, MacKay Memorial Hospital1; Mackay Medical College1;
School of Medican, National Yang-Ming University2
Background: Androgen deprivation therapy (ADT) was applied to prostate cancer for over 10 years. There is increasing evidence that ADT may increase risk of depression. A research in the Taiwan Longitudinal Health Insurance Database 2005 presents epidemiological evidence of an association between ADT and a subsequent depression disorder diagnosis. We administered PHQ9 to consecutive prostate cancer patients who had ADT therapy.
Materials and methods: This was a cross-sectional study. Between January 2015 and June 2017, we search the patient with prostate adenocarcinoma and ADT code in Mackay Memorial hospital. The inclusion criteria include pathology-proof prostate adenocarcinoma with ADT therapy. The exclusion criteria were patients with radical prostatectomy, orchiectomy, other malignancy, ECOG status more than 1, PSA not in the nadir, testosterone not in the castration level and progressive disease in the image. All the patients were followed by urologists and surveyed using PHQ9 and laboratory data (Hb, PSA and testosterone). Patient with PHQ9 scores more than 5 had a high risk of depression. All data were compared using t-test and chi-square test, as appropriate. Statistical significance was set at p < 0.05.
Results: The number of patient with androgen deprivation therapy was 197. Among the 197 patients, 73 patient was compatible with inclusion criteria and patients with irregular ADT use (25), loss follow up (19), no pathology proof in hospital(18), CRPC(18), double cancer(13), triple cancer(1), post radical prostatectomy(10), post-orchiectomy(3), ECOG>2(7) and 2nd-line ADT use(3) were excluded. Among 73 patients, 58 patients completed the exam and other 15 patients rejected the exam. The number of patient with high risk of depression (PHQ9 score>=6) was 21(36%). The average age of pateints was 72.5±7.8 years old and average PHQ9 scores was 4.7±0.5. We divided patients into two groups, patient with high risk of depression (PHQ9>=6) and normal risk of depression (PHQ9<6). There was no significant difference in parameters such as age, cancer stage, initial PSA, current Hb, current PSA, current testosterone, ADT use duration (months) and bone metastasis(yes vs. no) between two groups. (p>0.05) The relationship between PHQ9 score 9 and parameters was irrelevant.
Conclusion: Our study showed number of patient with higher risk of depression was 36%, compatible with other studies. However, there was no parameter correlated with PHQ9 scores. Our limitation was small sample size and more patients would be recruited for this study.