Fri Aug 9

Many men diagnosed with prostate cancer experience poor mental health. We need to support them better

Written by: Tenaw Tiruye, Postdoctoral Researcher, Cancer Epidemiology and Population Health, University of South Australia

Every year more than 24,000 Australian men ^[1] are diagnosed with prostate cancer, making it the most frequently diagnosed cancer among Australian men.

Despite high survival rates – around 96%^[2] of men diagnosed with prostate cancer will survive for at least five years – prostate cancer can significantly affect mens’ mental wellbeing. This can apply through all stages of the illness, including diagnosis, treatment and follow up.

Rates of anxiety, depression ^[3] and suicide are higher ^[4] among men with prostate cancer than in the general population.

In our recent study ^[5], we wanted to understand the scale and timing of mental health issues among men with prostate cancer. Our findings suggest we need to offer them more support, sooner.

What we found

We looked at 13,693 men diagnosed with prostate cancer in South Australia between 2012 and 2020. We analysed prostate cancer registry data alongside data from the Pharmaceutical Benefits Scheme and the Medicare Benefits Schedule.

Using this data, we tracked medication prescriptions (such as antidepressants and anti-anxiety medications) and mental health service use (such as GP mental health visits and psychiatrist visits) five years before and five years after prostate cancer diagnosis.

We found the proportion of men using antidepressants or anti-anxiety medications rose from 34.5% five years before a diagnosis to 40.3% five years afterwards. Some 10.2% used mental health services five years before, compared with 12.1% five years afterwards. GP mental health visits were most common, rising from 7.8% to 10.6%.

The most significant increase in the use of medicines and health services for mental illness occurred around the time of prostate cancer diagnosis. Some 15% of men started on antidepressants or anti-anxiety medications at the time of their diagnosis, while 6.4% sought help from mental health services for the first time.

A young man talking to a young female therapist.

We looked at medication and use of mental health services. PeopleImages.com - Yuri A/Shutterstock ^[6]

Notably, the true impact of a prostate cancer diagnosis on men’s mental health is likely to be underestimated in our study. We only looked at mental health services subsidised by Medicare, but some men may access mental health services privately or through community services. And of course, some men with mental health issues may not seek help at all.

Men may be less likely to seek help

Our research suggests there’s a tendency for men to take medication rather than get help from mental health services. This may reflect a preference for medication, but could also be due to limited availability of services, or stigma around getting help.

Research shows many cancer patients are reluctant to seek help ^[7] for mental health concerns.

Evidence on general help-seeking behaviours suggests men may be even less likely ^[8] to seek support than women. Whether it’s the stigma surrounding mental health, or a fear about being seen as weak, only one-quarter of men ^[9] say they would seek help from a mental health professional if they were experiencing personal or emotional problems.

A health-care worker talks to a patient in a wheelchair in a hospital.

More than 24,000 men are diagnosed with prostate cancer in Australia each year. Halfpoint/Shutterstock ^[10]

Early intervention is key

Given the trends in medication and mental health service use we observed in our study, men appear to be most vulnerable to psychological issues around the time of their prostate cancer diagnosis. This vulnerability might stem from the stress of being diagnosed with cancer, treatment decisions, and concerns about the future.

As such, there would be value in incorporating mental health screening into routine prostate cancer diagnosis processes. Early identification of mental health issues ^[11] is important to pave the way for timely interventions and support, which can significantly improve mental wellbeing.

Rather than waiting for men to proactively seek out mental health supports after they’ve been diagnosed with prostate cancer, we should be offering those identified by such screening support at diagnosis and throughout treatment.

What do we need to do?

Psychological issues are one of the most frequently reported unmet needs among men with prostate cancer.

Improving access to mental health care may include increasing the annual sessions ^[12] of Medicare-subsidised mental health services and offering more access to GP mental health plans for men with prostate cancer.

Initiatives such as counselling services offered by the Prostate Cancer Foundation of Australia ^[13] and the Cancer Council ^[14], as well as the appointment of prostate cancer nurses, could be expanded.

It would also be worthwhile to expand telehealth services ^[15]. These provide an important option where costs or distance may make access to mental health services difficult for some prostate cancer patients.

Finally, we must normalise mental health discussions to ensure men with prostate cancer have every opportunity to voice their struggles and get the support they need.

This is particularly important given the wide-ranging effects of mental health problems on a person’s quality of life, health outcomes ^[16], and the overall burden on the health system.