Decreasing suicide risk among patients with prostate cancer: Implications for depression, erectile dysfunction, and suicidal ideation screening

Zachary Klaassen, Karan Arora, Shenelle N. Wilson, Sherita A. King, Rabii Madi, Durwood E. Neal, Paul Kurdyak, Girish S. Kulkarni, Ronald W. Lewis, Martha K. Terris

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


Objective: Prostate cancer is the most common malignancy among males, accounting for 19% of cancers, and the third most common cancer-related cause of death. Suicide rates in the United States have increased among males over the last decade. Further, suicide rates are higher in oncology patients, including patients with prostate cancer, compared to the general population. The objective of this article is to review the current literature and address the relationship between prostate cancer, depression, erectile dysfunction, and suicidal ideation. Materials and methods: We reviewed the current literature pertaining to prostate cancer and depression, and prostate cancer and suicide. Furthermore, associations were made between erectile dysfunction and depression. Results: Men with prostate cancer at increased risk for suicidal death are White, unmarried, elderly, and men with distant disease. Time since diagnosis is also an important factor, since men are at risk of suicide>15 years after diagnosis. Approximately 60% of men with prostate cancer experience mental health distress, with 10%–40% having clinically significant depression. Additionally, patients that received androgen deprivation therapy (ADT) are 23% more likely to develop depression compared to those without ADT. Longitudinal studies of prostate cancer patients suggest that erectile dysfunction after curative treatment may have a significant psychological effect leading to depression. Herein, a newly proposed screening algorithm suggests for an evaluation with the expanded prostate cancer index composite-clinical practice, patient health questionnaire-9, and an 8-question suicidal ideation questionnaire to assess for health-related quality of life, depression, and suicidal ideation. Conclusion: The burden of screening for erectile dysfunction, depression and suicidal ideation lies with the entire health care team, as there appears to be an association between these diagnoses, that is, compounded in patients with prostate cancer. The screening algorithm should assist with guiding timely and appropriate psychiatric referral to optimize outcomes in these high-risk patients.

Original languageEnglish (US)
Pages (from-to)60-66
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Issue number2
StatePublished - Feb 2018


  • Depression
  • Erectile dysfunction
  • Prostate cancer
  • Quality of life
  • Suicidal ideation
  • Suicide
  • Survivorship

ASJC Scopus subject areas

  • Oncology
  • Urology


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