(P060) Impact of Major Psychiatric Disorders on Tolerance and Outcomes for Men With Prostate Cancer Undergoing Dose-Escalated Radiation Therapy

Joseph Safdieh, MD, J. Rineer, MD, A. Wong, MD, D. Schwartz, MD, D. Schreiber; SUNY Downstate Medical Center; University of Florida Health Cancer Center at Orlando; Department of Veteran Affairs, NY Harbor Campus

PURPOSE/OBJECTIVES: Prior studies have revealed that patients with psychiatric disorders and prostate cancer have worse survival outcomes compared with the general population. However, many of these studies have associated these outcomes with delayed diagnosis and/or reduced access to definitive treatment. The purpose of this study was to investigate the toxicity and outcomes of patients with or without psychiatric disorders who were a primarily prostate-specific antigen (PSA)-screened population and who accepted definitive treatment with external beam radiation.

MATERIALS AND METHODS: The charts of 469 patients diagnosed with prostate cancer from 2003–2010 who were treated with external beam radiation (minimum dose 7,560 cGy) were reviewed. Patients were identified as having no psychiatric disorder (−Psy) or having a psychiatric disorder (+Psy) consisting of a Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnosis of posttraumatic stress disorder, depression, schizophrenia, bipolar disorder, or generalized anxiety disorder. Kaplan-Meier analysis was used to analyze biochemical control, distant control, prostate cancer–specific survival, and overall survival (OS). Multivariate Cox regression was used to look for covariates associated with toxicity or biochemical control.

RESULTS: The charts of 469 patients were reviewed, and 100 patients (21.3%) were found to be +Psy. At a median follow-up of 73 months, there was no difference between the two groups regarding 6-year biochemical failure–free survival (79.8% −Psy vs 80.4% +Psy; P = .50) or 6-year distant metastatic-free survival (96.4% −Psy vs 98.0% +Psy; P = .36). There were also no differences regarding 6-year prostate cancer–specific survival (98.4% −Psy vs 99.0% +Psy; P = .45) or 6-year OS (80.2% −Psy vs 82.2% +Psy; P = .35). Likewise, short- and long-term genitourinary and gastrointestinal toxicities were similar between the groups. On multivariate analyses, the presence of +Psy was not a significant predictor for toxicity or biochemical recurrence.

CONCLUSIONS: This study did not find any significant differences in treatment tolerance or any outcome endpoints between men with and without psychiatric disorders undergoing definitive radiation treatment for prostate cancer. This finding suggests that early diagnosis and reduced barriers to definitive treatment will alleviate the decreased cancer-specific mortality in this patient population.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org