From the Guidelines
There is no established direct link between selective serotonin reuptake inhibitors (SSRIs) and prostate adenocarcinoma, and patients with prostate cancer can generally continue taking prescribed SSRIs for depression, anxiety, or other conditions without concern for worsening their cancer. Patients with prostate cancer can generally continue taking prescribed SSRIs for depression, anxiety, or other conditions without concern for worsening their cancer. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil), typically dosed once daily 1. Some studies have actually suggested that SSRIs might have mild anti-cancer properties through mechanisms involving apoptosis (programmed cell death) in cancer cells, though this hasn't translated to clinical recommendations for cancer treatment.
The management of depression and anxiety in patients with cancer, including those with prostate adenocarcinoma, is crucial for improving their quality of life. The NCCN guidelines recommend psychotherapy with or without an anxiolytic or an antidepressant for the treatment of anxiety, after eliminating medical causes 1. SSRIs are widely used for depression and anxiety symptoms, and research suggests that they are beneficial in the treatment of depression and anxiety in adult patients with cancer 1.
Patients should be aware that SSRIs may interact with certain medications used in prostate cancer treatment, particularly some pain medications and antiandrogens, so medication reconciliation is important. The most common side effects of SSRIs include nausea, headache, insomnia, and sexual dysfunction, with the latter being particularly relevant to discuss with prostate cancer patients who may already experience sexual side effects from cancer treatments. Any decision regarding SSRI therapy should balance mental health benefits against potential side effects in the context of ongoing cancer treatment.
Key points to consider when prescribing SSRIs to patients with prostate adenocarcinoma include:
- Monitoring for potential interactions with other medications
- Discussing potential side effects, particularly sexual dysfunction
- Balancing mental health benefits against potential side effects
- Considering the patient's overall quality of life and cancer treatment plan. It is also important to note that the use of SSRIs in patients with prostate cancer is not addressed in the provided evidence 1, which focuses on the treatment of premature ejaculation. However, the general principles of SSRI use and potential side effects can still be applied to patients with prostate cancer.
From the Research
SSRI and Adenocarcinoma of the Prostate
- The relationship between SSRI use and adenocarcinoma of the prostate has been investigated in several studies.
- A study published in 2008 2 found no significant association between SSRI use and the risk of prostate cancer.
- Another study from 2006 3 evaluated the efficacy of paroxetine, an SSRI, in treating hot flashes in patients with prostate cancer undergoing androgen-deprivation therapy, and found it to be helpful.
- Research from 1995 4 demonstrated that serotonin-uptake inhibitors, including fluoxetine, inhibited the growth of human prostate carcinoma cell lines in a dose-dependent manner.
- However, a study from 2018 5 focused on breast cancer survival and found an association between SSRI use and increased breast cancer-specific mortality, but this may not be directly relevant to prostate cancer.
- A review from 2004 6 discussed the potential therapeutic role of alpha-blockers in the management of prostate cancer, but did not address SSRIs specifically.
Key Findings
- No significant association between SSRI use and prostate cancer risk was found in a population-based case-control study 2.
- SSRIs may be helpful in treating hot flashes in patients with prostate cancer undergoing androgen-deprivation therapy 3.
- Serotonin-uptake inhibitors have been shown to inhibit the growth of human prostate carcinoma cell lines in vitro 4.