Impact of Prostate Cancer-related Genitourinary Radiation Injury on Mental Health Diagnosis and Treatment: Assessment of 55,425 Men.

To investigate the association of low-grade radiation injury (LGRI) and high-grade radiation injury (HGRI) following prostate cancer treatment with mental health diagnoses and therapy. A retrospective study of men diagnosed with prostate cancer who were treated with radiotherapy. Men were followed to assess for LGRI or HGRI using IBM MarketScan. Cohorts included: no injury (no-RI), LGRI, HGRI, and controls. Mental health diagnoses and related treatment (medication/therapy) were identified using ICD-10 codes, CPT codes, and national drug codes. A multivariable Cox proportional hazards model from time of radiation to first instance of mental health diagnosis was modeled against injury group, age, and comorbidities. Between 2011 and 2020 we identified 55,425 men who received radiotherapy for prostate cancer. 22,879 (41.3%) experienced a LGRI while 4128 (7.4%) experienced a HGRI. Prior to radiation therapy, mental health diagnoses were equally distributed across cohorts (P > .05). Every marker of mental health showed a step-wise increase in incidence from no-RI to LGRI to HGRI except for alcohol abuse. Use of mental health medications and therapy visits were slightly more likely in the LGRI and HGRI groups prior to radiation, however, this difference was greatly increased postradiation therapy. LGRI (HR 1.38; P < .001) and HGRI (HR 2.1; P < .001) were independently associated with an increased likelihood of mental health diagnoses. LGRI and HGRI following prostate cancer radiotherapy are associated with increased risk of mental health diagnosis, medication use, and therapy need compared to men who do not develop injuries. The most common mental health diagnoses were depression and anxiety.

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Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: James Hotaling: Boston Scientific, Acerus, Coloplast, Endo: research/fellowship grants. Consultant/Advisor/Advisory Board Member. Turtle health (paid consultant, no equity) female point of care fertility company. Maximus (hormone company) equity as consultant on advisory board, no compensation. FirmTech, early stage start up making a consumer ring to monitor erectile rigidity/duration salary (<50k)/equity, no product on market yet, CMO. StreamDx: board member/co-founder, FDA approved home uroflow device on market (equity, no salary). Inherent bioscience (male fertility epigenetics company), equity in early stage start up. Jeremy Myers: Cooper Medical: Consultant; Honorarium.