2023 The Stewart J. Rahr Foundation-PCF VAlor Young Investigator Award

Impact of Androgen Receptor Signaling Inhibitors on Depression and Anxiety in Veterans with Metastatic Hormone-Sensitive Prostate Cancer

Phoebe Tsao, MD
University of Michigan

Mentors: Megan Caram, Joshi Alumkal

Description:

  • Androgen receptor signaling inhibitors (ARSIs) have recently become the standard of care for treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Prior work in castration-resistant prostate cancer (CRPC) demonstrated an association between ARSIs and incident depression, but little is known about the impact of ARSIs on depression and anxiety in patients with mHSPC.
  • Patients with mHSPC receive ARSIs continuously for on average three years – over twice as long as patients with CRPC – increasing the potential for mental health toxicity. Experiencing depression while living with cancer has significant implications including decreased clinical trial participation, worse quality of life, and increased health care utilization, cost, and mortality.
  • Depression and anxiety are of particular importance to Veterans with mHSPC as they tend to have higher rates of mental health symptoms and suicide than non-Veterans.
  • Phoebe Tsao and team are investigating the extent and predictors of depression and anxiety in Veterans with mHSPC undergoing treatment with ARSIs, to identify optimal interventions that will not only help patients maintain their quality of life, but also remain on critical, standard of care therapy.
  • In this project, Dr. Tsao and team will use the VA’s extensive electronic health records database to determine the frequency and severity of depression, anxiety, and suicide in Veterans with mHSPC beginning ARSIs.
  • The association between experiencing depression or anxiety and prostate cancer outcomes will be determined.
  • Mental health care practice patterns linked with improved mental health outcomes, prostate cancer outcomes, and overall survival will be identified.
  • If successful, this project will elucidate the impact of long-term ARSI treatment on mental health and determine which mental health care delivery systems are most effective for mitigating mental health side effects. This will lay the foundation for future clinical trials testing interventions for reducing depression and anxiety in patients with mHSPC, ultimately helping all patients treated with ARSIs to live both longer and better.

What this means to patients: ARSIs are standard-of-care therapies for patients for advanced prostate cancer but may increase risk for mental health toxicities including depression and anxiety. Dr. Phoebe Tsao and team are investigating the prevalence of mental health toxicities and identifying optimal mental health care interventions in Veterans with mHSPC undergoing treatment with ARSIs. These studies will help to identify optimal mental health care delivery systems that reduce depression and anxiety and increase adherence rates to ARSI therapy, ultimately improving survivorship in Veterans and all men with advanced prostate cancer.