Research Article: Immediate Risk for Cardiovascular Events and Suicide Following a Prostate Cancer Diagnosis: Prospective Cohort Study

Date Published: December 15, 2009

Publisher: Public Library of Science

Author(s): Katja Fall, Fang Fang, Lorelei A. Mucci, Weimin Ye, Ove Andrén, Jan-Erik Johansson, Swen-Olof Andersson, Pär Sparén, Georg Klein, Meir Stampfer, Hans-Olov Adami, Unnur Valdimarsdóttir, Eduardo L. Franco

Abstract: Katja Fall and Fang Fang and colleagues find that men newly diagnosed with prostate cancer are at increased risk of cardiovascular events and suicide.

Partial Text: Growing evidence suggests that stressful events, such as the loss of a child, war, or natural disasters, lead to an increased risk of psychiatric hospitalizations [1] and cardiovascular morbidity [2] with excess mortality [3]–[6]. Less is known about whether emotional stress evoked by a cancer diagnosis increases the risks of cardiovascular events and suicide, especially immediately after diagnosis. Such possible consequences are of specific interest for prostate cancer, which is now the most common malignancy among men in westernized countries. Widespread prostate-specific antigen (PSA)-testing has further entailed detection of large numbers of men with uncertain survival benefit [7],[8]. The increased diagnostic activity calls for new knowledge on possible stress-induced health effects that may be caused by the diagnosis. Using the nationwide Swedish population-based registers, we assessed whether men diagnosed with prostate cancer were at increased risks of cardiovascular events and suicide during the year after their diagnosis, in particular during the first weeks following diagnosis.

We utilized the Swedish Census data that cover virtually all residents in Sweden in 1960, 1970, 1980, and 1990. We identified 4,305,358 men, born in Sweden and at age 30 y or older between January 1, 1961 and December 31, 2004. Using the national registration number, an individually unique identifier of all Swedish inhabitants, we were able to link Census information with the Swedish Cancer, Causes of Death, and Inpatient Registers and calculate incidence rates of cardiovascular events and suicide. The study was approved by the Regional Ethics Committee at the Karolinska Institutet.

Between 1961 and 2004, a total of 4,305,358 men were followed with over 90 million unexposed person-years and approximately 150,000 person-years among men newly diagnosed with prostate cancer. The mean age at diagnosis of prostate cancer was 73.4 y (range 31.6–102.5 y). Of 168,584 men diagnosed with prostate cancer, 10,126 (6%) experienced a cardiovascular event during the year following diagnosis and 136 (0.08%) committed suicide.

In this large population-based study, men newly diagnosed with prostate cancer were at higher risks of cardiovascular events and suicide. The excess risks were highest during the first week after diagnosis, suggesting that the stress of diagnosis itself rather than subsequent factors such as hormonal treatment or operations plays a role. Also, we observed the highest excess risk of cardiovascular events among younger men, for whom the potential loss of years to live, of sexual potency, and of other aspects of life might be of greater concern than in older men.



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