Prostate cancer is one of the most common cancers to affect men, with about one in seven diagnosed during his lifetime.
This year, about 161,360 new cases of prostate cancer will be diagnosed, and about 26,730 men will die from the disease, according to the American Cancer Society. It is the third leading cause of cancer death in American men, behind lung and colorectal cancer.
But prostate cancer doesn’t just affect men physically. Men diagnosed with prostate cancer face a unique set of emotional issues. The diagnosis of cancer in itself can be overwhelming enough, but the stigma associated with prostate cancer often prevents them from seeking emotional help, according to experts at City of Hope.
“Prostate cancer patients face multiple emotional issues,” said Chandana Banerjee, M.D., M.P.A, assistant clinical professor in the Department of Supportive Care Medicine at City of Hope. “At the time of diagnosis, patients can experience a variety of emotions, from fear to anxiety. Studies show that patients fear progression of the disease and the impact it might have on their relationships. Effects of prostate cancer on sexual health are often a major concern, and we encourage patients to be verbal about their thoughts and feelings.”
Some of the adverse effects of prostate cancer are fatigue, increased pain, sleep disturbances, frequent urination, hot flashes, depression, anxiety, decreased libido, changes in sexual functioning and discomfort about being sexually intimate with partners, according to Banerjee.
“There is often a sense of emasculation and guilt for not being able to have intimate relationships due to anxiety and fear. Patients with loss of libido and erectile dysfunction are at increased risk of depression, fatigue, anxiety, irritability and fear of disease progression.”
However, “Multiple treatments exist, including medications, prostheses and both sex therapy and couples’ therapy to help patients and their partners find alternative ways to connect intimately throughout treatment,” added Kimberly Shapiro, M.D., a psychiatrist at City of Hope and assistant clinical professor in the Department of Supportive Care Medicine.
Treatment for prostate cancer involves hormonal therapy, radiotherapy and surgery. The side effects seen with hormonal therapy can often impact a patient’s emotional health, Banerjee said. Physical effects of hormone therapy include loss of muscle and bone mass, redistribution of fat, obesity and diabetes, “and these physical changes can evoke anxiety and depression in patients,” she said. “Psychologists can be employed to help with supportive, cognitive and behaviorally oriented therapies, and psychiatrists can prescribe antidepressants and medications for anxiety. Medications may reduce psychiatric barriers to improved coping.”
In addition, pain in and of itself can cause depressive symptoms and changes in emotional states, but both medication and pain-specific therapy can ameliorate these symptoms, Banerjee said.
“Weakness and fatigue caused by the illness itself, hormones, steroids and other cancer-related medications can be particularly upsetting to previously active, independent men who are now dependent on family or caretakers. Exercise and strength-training, identifying realistic goals, stimulants and antidepressants can all be used to increase energy,” Shapiro added.
Patients can also experience cognitive decline with treatments, with changes in memory and concentration, she said. “Neuropsychological evaluations may be useful.”
Support groups are often helpful in decreasing anxiety and depression, she continued, “and resources also exist for caretakers to prevent burnout.”
The good news is that while prostate cancer can be a serious disease, most men diagnosed with it do not die from it.
In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today, according to the American Cancer Society. That makes it even more essential that these survivors’ emotional needs are addressed.