Sperling Prostate Center

Men’s Health: Prostate Cancer and Depression

Mental health among men has been called a silent crisis. The myth that men don’t suffer psychologically traces back to Freudian stereotypes of women as fragile and prone to nervous breakdowns, neurosis and hysteria. According to this worldview, men are the stronger of the two sexes—as if they have always been invulnerable to mental and emotional weaknesses.

In fact, there are some very real gender differences. A classic study published in 2011 reported that females are more likely to be diagnosed with anxiety or depression, while male psychological distress tend to show up as substance abuse or antisocial disorders. Put another way, women are more likely to show up as “neurotic” while men have “behavior problems.”

There are many theories regarding this apparent gender difference. A prevailing one is that men are expected to be strong, silent types—so they accommodate to society’s big-boys-don’t-cry expectations. The stigma attached to being “crazy” (or psycho or weirdo or loony) further incentivizes men to stuff their feelings. Angry outbursts may seem preferable to emotional vulnerability, or a bout of depression so deep that he needs psychiatric help.

Confusing chronic mental illness with situational distress

However, it’s important to not confuse situational distress with chronic mental illness. This is especially true during times trauma like a natural disaster, loss of a loved one, financial stress, etc. It is normal to experience unmanageable anxiety, depression, mood swings, obsessive thinking, substance abuse, etc.

This has been observed when a person is diagnosed with a life-threatening disease like cancer:

Emotional distress following a diagnosis of cancer is a normal and anticipated, but it may manifest in some individuals at some point as a level of anxiety or depression that significantly affects quality of life and coping. In extreme cases, these feelings can move from physical symptoms of low energy and inability to complete basic tasks to despair and hopelessness.[i]

If these issues are severe, it may warrant individual, couples or family therapy to help navigate through the hard time. While these problems often have identical symptoms with chronic mental illness, it does not mean the person is psychologically or psychiatrically unbalanced. Whether short- or longer-term, the person will get through it.

Prostate cancer and depression

Take a prostate cancer (PCa) scenario. If a patient is diagnosed with early-stage, low-risk PCa, it is to be expected that anxiety and stress will surge for him and his loved ones. However, in the vast majority of instances, it will be short-lived: treatment decisions are made and implemented, side effects (if any) are faced and dealt with, and a successful outcome is anticipated. Eventually, life returns to business as usual, and the patient regains his typical outlook and quality of life.

However, not all PCa is diagnosed when there’s good odds of eliminating it for the rest of a man’s natural life. When a patient learns he has high-risk disease requiring aggressive and invasive treatment, with a higher likelihood of treatment side effects and risk of recurrence, it can be crushing. It can lead to such severe turmoil and distress that the patient develops major depression—in itself a potential life threat. A newly published (Sep. 2023) paper by an international, multicenter and multidisciplinary team investigated the risk of a long-term mental impact on high-risk PCa patients. It was a population-based analysis of 180,189 PCa patients diagnosed from 1998-2017, matched with 1,801,890 control men (data drawn from a Swedish national health registry). Compared with the control group,

Men diagnosed with high-risk PC had higher relative rates of major depression and death by suicide. These associations persisted for ≥10 yr after PC diagnosis. … By contrast, men with low- or intermediate-risk PC had a modestly higher relative rate of major depression and higher relative rate of suicide death at 3–12 mo after PC diagnosis but not across the entire follow-up period.[ii]

There were also treatment-related differences. Men who had radiation or surgery had less increase in major depression than those who were placed on androgen deprivation therapy (ADT or chemical castration), and those treated only with ADT had a higher rate of suicide. This may be due to the nature of this therapy, which has a huge negative effect on a man’s physical and psychological quality of life.

The authors concluded that high-risk PC was linked with “substantially higher” rates of long-term major depression and suicide (10 or more years after PCa diagnosis). They recommend that prostate cancer survivors “…need close follow-up for timely detection and treatment of psychosocial distress.”[iii] These findings are consistent with other published studies revealing two clear themes: “…a cancer diagnosis with or without pre-existing mental health comorbidities is a risk factor for suicide; and that there is a significant incidence and prevalence of anxiety and depression in cancer patient populations.”[iv]

Thus, it is important to recognize and be sensitive to the emotional state of PCa patients, especially those who are diagnosed with high-risk PCa, accompanied by aggressive treatments—and especially those who are on ADT over a long duration. Encouraging PCa patients to tune into their feelings, and supporting them in expressing what’s going on in their minds and hearts, would be a contribution not only to men’s physical health, but also their emotional and psychological wellness.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Fiona Milligan. “Suicide and Women Living with and Beyond a Beast Cancer Diagnosis.” British Journal of Nursing. Oct. 2022. https://www.britishjournalofnursing.com/content/professional/suicide-and-women-living-with-and-beyond-a-breast-cancer-diagnosis/
[ii] Crump C, Stattin P, Brooks JD, Sundquist J, Bill-Axelson A, Edwards AC, Sundquist K, Sieh W. Long-term Risks of Depression and Suicide Among Men with Prostate Cancer: A National Cohort Study. Eur Urol. 2023 Sep;84(3):263-272.
[iii] Ibid.
[iv] Fiona Milligan, ibid.


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

You may also be interested in...

WordPress Image Lightbox