Cognitive function, depression, and anxiety in patients undergoing radical prostatectomy with and without adjuvant treatment

Figures & data

Figure 1 Simple reaction time test results in the study and control groups.

Abbreviations: SRT-C, simple reaction time test (number of correct answers); SRT-RT, simple reaction time test (average reaction time).

Figure 2 VMT and VMDT results in the study and control groups.

Abbreviations: VMT, verbal memory test; VM-1 to VM-5, verbal memory (number of words remembered in each of the five attempts); VMDT, verbal delayed memory test (number of words remembered).

Figure 3 GoNoGo test results in the study and control groups.

Abbreviations: GoNoGo-C, GoNoGo test (number of correct answers); RT, reaction time; IncGo, number of incorrect Go answers; IncNoGo, incorrect NoGo answers.

Figure 4 VWMT results in the study and control groups.

Abbreviations: VWMT-C, visual working memory test (number of correct answers); CRT, average response time for correct answers.

Table 1 Demographic and clinical data of the two prostate cancer therapy subgroups

Parameter	Total (n=100)	Prostatectomy only (n=77)	Prostatectomy and adjuvant treatment (n=23)	Cohen’s d	p-value
Age (years)	66.0 (60.0–70.0)	66.0 (60.0–70.0)	65.0 (60.0–71.0)	0.16	0.95
BMI (kg/m^2)	27.1 (25.1–29.7)	26.7 (24.7–29.4)	27.7 (25.7–31.5)	0.36	0.11
Diabetes (n, %)	13 (13%)	11 (14%)	2 (8.5%)		0.69
Hypertension (n, %)	56 (56%)	42 (54.5%)	14 (61%)		0.64
MI (n, %)	9 (9%)	6 (9.5%)	3 (13%)		0.71
Stroke (n, %)	7 (7%)	6 (9.5%)	1 (4%)		0.81
Education
Basic (n, %)	5 (5%)	5 (6.5%)	0 (0%)		0.85
Vocational (n, %)	28 (28%)	19 (24.5%)	9 (39%)
Secondary (n, %)	34 (34%)	29 (37.5%)	5 (22%)
Higher (n, %)	33 (33%)	24 (31.5%)	9 (39%)
Physical activity
None (n, %)	34 (34%)	24 (31%)	10 (43.5%)		0.34
<1×/week (n, %)	31 (31%)	20 (26%)	11 (48%)
<3×/week	35 (35%)	33 (43%)	2 (8.5%)
Nicotinism (n, %)	47 (47%)	37 (48%)	10 (43.5%)		0.74
Erectile dysfunction before surgery (0/1) (n, %)	6 (6%)	2 (2.5%)	4 (14%)		0.96
Erectile dysfunction after surgery (0/1) (n, %)	20 (20%)	2 (2.5%)	18 (78%)		0.022
Time from surgery (months)	19.0 (12.0–39.0)	19.0 (12.0–39.0)	17.0 (13.0–27.0)	0.15	0.67
Grade group	1.0 (1.0–2.0)	1.0 (1.0–2.0)	2.0 (1.0–4.0)	1.02	0.0002
TNM classification primary tumor staging
T2N0 (n, %)	1 (1%)	1 (15%)	0 (0%)		0.01
T2A (n, %)	13 (13%)	13 (16.5%)	0 (0%)
T2B (n, %)	1 (1%)	0 (0%)	1 (4.5%)
T2C (n, %)	64 (64%)	61 (79%)	3 (13%)
T3A (n, %)	10 (10%)	0 (0%)	10 (43.5%)
T3B (n, %)	8 (8%)	1 (1.5%)	7 (30%)
T3C (n, %)	3 (3%)	1 (1.5%)	2 (9%)

Notes: Data are shown as the median (25th–75th quartile) or number (%). Inter-group differences were assessed using the Mann–Whitney U-test. Effect size was measured using the Cohen’s d method. Significant p-values are shown in bold.

Abbreviations: BMI, body mass index; MI, myocardial infarction; 0/1, presence or absence of erectile dysfunction.

Table 2 Psychological, clinical, and biochemical parameters in prostate cancer therapy subgroups

Parameter (ref value)	Total (n=100)	Prostatectomy only (n=77)	Prostatectomy and adjuvant treatment (n=23)	Cohen’s d	p-value
HADS-Anxiety	3.0 (1.0–7.0)	3.0 (1.0–6.0)	5.0 (3.0–9.0)	0.70	0.01
HADS-Depression	3.0 (1.0–6.0)	2.0 (1.0–4.0)	4.0 (2.0–8.0)	0.77	0.027
ICIQ-total	3.0 (0.0–8.0)	2.0 (0.0–7.0)	7.0 (0.0–13.0)	1.1	0.045
IIEF-5	0.0 (0.0–7.0)	0.0 (0.0–8.0)	0.0 (0.0–5.0)	0.61	0.31
PSA-1 (<4.1 ng/mL)	7.5 (5.4–10.6)	7.1 (5.2–9.3)	10.3 (6.4–17.0)	0.8	0.035
PSA-2 (<4.1 ng/mL)	0.003 (0.003–0.037)	0.003 (0.003–0.017)	0.008 (0.003–0.14)	0.09	0.045
Testosterone (1.23–8.92 ng/mL)	4.63 (3.15–6.26)	5.2 (3.49–6.4)	3.56 (2.47–4.5)	0.70	0.001

Notes: Data are shown as the median (25th–75th quartile). Inter-group differences were assessed using the Mann–Whitney U-test. Effect size was measured using the Cohen’s d method. Significant p-values are shown in bold.

Abbreviations: HADS, Hospital Anxiety and Depression Scale; ICIQ, International Consultation on Incontinence Modular Questionnaire; IIEF-5, International Index of Erectile Function; PSA, prostate-specific antigen; Ref value, reference values.

Table 3 Cognitive test results for the prostate cancer therapy subgroups

Parameter	Total (n=100)	Prostatectomy only (n=77)	Prostatectomy and adjuvant treatment (n=23)	Cohen’s d	p-value
SRT-C	25.0 (25.0–25.0)	25.0 (25.0–25.0)	25.0 (25.0–25.0)	0.005	0.92
SRT-RT (ms)	280.8 (234.3–319.1)	281.3 (234.6–316.9)	274.7 (233.3–343.9)	0.29	0.73
VM-1	5.0 (4.0–7.0)	5.0 (5.0–6.0)	5.0 (4.0–7.0)	1.52	0.60
VM-2	7.0 (6.0–8.0)	7.0 (6.0–8.0)	7.0 (6.0–8.0)	0.06	0.95
VM-3	7.0 (7.0–8.0)	7.0 (7.0–8.0)	8.0 (6.0–8.0)	0.07	0.83
VM-4	8.0 (7.0–10.0)	8.0 (6.0–10.0)	8.0 (7.0–10.0)	0.05	0.62
VM-5	8.0 (7.0–10.0)	8.0 (6.0–10.0)	8.0 (7.0–10.0)	0.05	0.64
VMDT	6.0 (5.0–7.0)	6.0 (5.0–7.0)	5.0 (4.0–7.0)	0.64	0.04
GoNoGo-C	74.0 (73.0–75.0)	74.0 (73.0–75.0)	74.0 (73.0–75.0)	0.10	0.90
GoNoGo-RT (ms)	365.8 (323.6–414.3)	366.2 (326.4–419.6)	363.1 (310.4–397.5)	0.25	0.39
GoNoGo IncGO	1.0 (0.0–2.0)	1.0 (0.0–2.0)	1.0 (0.0–2.0)	0.28	0.89
GoNoGo IncNoGo	5.0 (2.0–8.0)	4.0 (2.0–7.0)	6.0 (3.0–9.0)	0.07	0.16
VWMT-C	5.0 (3.0–6.5)	6.0 (3.0–7.0)	5.0 (3.0–6.0)	0.09	0.64
VWMT-CRT (ms)	3,150.0 (2,570.0–4,441.0)	3,219.0 (2,578.0–4,266.0)	2,828.0 (2,562.0–4,586.0)	0.28	0.76
VWMT-IRT (ms)	3,499.0 (0.0–4,742.0)	3,484.0 (0.0–4,516.0)	3,515.0 (0.0–6,625.0)	0.12	0.57

Notes: Data are shown as the median (25th–75th quartile) or number (%). Inter-group differences were assessed using the Mann–Whitney U-test. Effect size was measured using the Cohen’s d method. Significant p-value is shown in bold.

Abbreviations: SRT-C, simple reaction time test (number of correct answers); SRT-RT, simple reaction time test (average reaction time); VM-1 to VM-5, verbal memory (number of words remembered in each of the five attempts); VMDT, verbal delayed memory test (number of words remembered); GoNoGo-C, GoNoGo test (number of correct answers); RT, reaction time; IncGo, number of incorrect Go answers; IncNoGo, incorrect NoGo answers; VWMT-C, visual working memory test (number of correct answers); CRT, average response time for correct answers; IRT, average response time for incorrect answers.

Table 4 R-Spearman correlations between cognitive test results and erectile function before and after surgery in all groups (n=100)

Parameter	Erection before surgery	p-value	Erection after surgery	p-value
SRT-C	−0.018	0.85	−0.17	0.09
SRT-RT	−0.14	0.16	−0.16	0.11
VM-1	0.14	0.16	−0.12	0.23
VM-2	0.18	0.07	−0.15	0.13
VM-3	0.08	0.42	−0.05	0.62
VM-4	0.09	0.37	0.02	0.84
VM-5	0.09	0.37	0.03	0.76
VMDT-C	0.12	0.23	0.12	0.23
GoNoGo-C	−0.04	0.69	0.09	0.37
GoNoGo-RT	−0.21	0.03	0.03	0.76
GoNoGo IncGO	0.04	0.69	−0.09	0.37
GoNoGo IncNoGo	−0.05	0.62	−0.17	0.09
VWMT-C	−0.03	0.76	0.27	0.006
VWMT-CRT	0.05	0.62	0.03	0.76
VWMT-IRT	−0.05	0.62	−0.13	0.13

Note: Significant p-values are shown in bold.

Abbreviations: SRT-C, simple reaction time test (number of correct answers); SRT-RT, simple reaction time test (average reaction time); VM-1 to VM-5, verbal memory (number of words remembered in each of the five attempts); VMDT-C, verbal delayed memory test correct answers (number of words remembered); GoNoGo-C, GoNoGo test (number of correct answers); RT, reaction time; IncGo, number of incorrect Go answers; IncNoGo, incorrect NoGo answers; VWMT-C, visual working memory test (number of correct answers); CRT, average response time for correct answers; IRT, average response time for incorrect answers.

Table 5 R-Spearman correlations between demographic, clinical, psychological, and biochemical factors and erectile function before and after surgery in all groups (n=100)

Parameter	Erection before surgery	p-value	Erection after surgery	p-value
Age (years)	−0.22	0.027	−0.23	0.02
BMI (kg/m^2)	−0.05	0.62	−0.29	0.003
Time from surgery (months)	–	–	0.28	0.004
PSA pre-surgery (ng/mL)	0.05	0.62	−0.11	0.27
PSA post-surgery (ng/mL)	−0.08	0.42	−0.21	0.03
PSA actual (ng/mL)	–	–	−0.05	0.62
Testosterone actual (ng/mL)	–	–	0.23	0.02
HADS-A	–	–	−0.23	0.02
HADS-D	–	–	−0.20	0.045

Note: Significant p-values are shown in bold.

Abbreviations: HADS, Hospital Anxiety and Depression Scale; BMI, body mass index; PSA, prostate-specific antigen.

Table 6 R-Spearman correlations between clinical scales and cognitive test results

Parameter	ICIQ-total	p-value	IIEF-5	p-value
VM-1	−0.14	0.16	−0.04	0.69
VM-2	−0.10	0.32	−0.13	0.19
VM-3	0.02	0.84	0.07	0.48
VM-4	−0.05	0.62	0.11	0.27
VM-5	−0.04	0.69	0.12	0.23
VMDT-C	−0.23	0.02	0.35	0.006
VWMT-C	−0.16	0.11	0.29	0.003
VWMT-CRT	0.16	0.11	0.02	0.84
VWMT-IRT	0.02	0.84	0.17	0.09
HADS-Anxiety	0.23	0.02	−0.22	0.02
HADS-Depression	0.38	0.00009	−0.13	0.19

Note: Significant p-values are shown in bold.

Abbreviations: HADS, Hospital Anxiety and Depression Scale; ICIQ, International Consultation on Incontinence Modular Questionnaire; IIEF-5, International Index of Erectile Function; VM-1 to VM-5, verbal memory correct answers (number of words remembered in each of the five attempts); VMDT-C, verbal delayed memory test correct answer (number of words remembered); VWMT-C, visual working memory test (number of correct answers); CRT, average response time for correct answers; IRT, average response time for incorrect answers.