Psychological Impact of Prostate Cancer
Disease Affects Men Physically as Well as Psychologically
Nov 4, 2009
There are many treatment options - such as surgical prostatectomy, radiotherapy, hormonal therapy, palliative care and even "no active treatment" - available for a man who is diagnosed with prostate cancer.
While much is made of the various effects and side effects of these different methods of therapy, it is often forgotten that the diagnosis and treatment of this condition can have a significant psychological impact, not only on the man himself but also on his partner.
Diagnosis of Prostate Cancer
Today, many men are diagnosed with prostate cancer before they have developed any symptoms of the disease because they have undergone a "screening" test long before any symptoms or signs of the condition have manifested themselves. Identifying cancer in this asymptomatic stage (when the patient himself is feeling perfectly well) requires a blood test, a physical examination and/or a biopsy. Suddenly coming to terms with the fact that one has a cancer - albeit a very slow growing cancer that is still at a curable stage - is associated with anxiety that can threaten a man's very self confidence and sense of masculinity.
Side Effects of Treatment
Two major side effects of prostate cancer therapy are Erectile dysfunction (impotence) and incontinence of urine.
Erectile Dysfunction
After both the common forms of treatment for prostate cancer (surgery and radiotherapy), erectile dysfunction (ED) is quite common - about 70% of men after therapy will experience this. Whether a man undergoes surgery (radical prostatectomy) or radiotherapy, the nerves associated with erection can be damaged- either completely or partially, and the effects can be permanent or temporary. Fortunately, in most men who had good erectile function prior to undergoing surgery, ED resolves with time - and is amenable to treatment with PDE5 inhibitor medications such as Viagra, Levitra or Cialis.
Incontinence of Urine After Prostate Surgery
This is rare - but is always a possibility. The greater the experience of the surgeon in performing this operation, the less the likelihood of incontinence occurring. However in removing the cancerous gland completely there is always a chance - albeit a small one - that the valve (or sphincter) controlling the outlet from the bladder can get damaged. Figures vary from hospital to hospital and surgeon to surgeon - but it is estimated that 1 to 5% of men undergoing radical prostatectomy are left with some degree of urinary incontinence after surgery.
Psychological Impact on Patient as Well as Partner
A diagnosis of prostate cancer has an impact on not only the man affected but also on the partner of this man, who has to confront the reality of a malignant disease and supporting him emotionally (and perhaps also financially) throughout therapy. This requires tremendous emotional strength and patience.
An interesting Australian study on the psychosocial effect of prostate cancer on couples found that the partners were more distressed at the time of diagnosis, and less so six months later, while the patients' anxiety and depression, although less than their partners' initially, increased with time.
Men by nature are reserved with their emotions, so it is vital that a man's partner takes part in discussions with the treating physicians and surgeons in order to be able to provide the support required as he undergoes therapy and learns to live with the disease.
Due to the significant psychological impact of prostate cancer, the provision of psychological therapy in the form of support groups and counselling for both the patient and his partner is essential to complement to the medical treatment of the cancer.
Reference:
The psychosocial impact of prostate cancer on patients and their partners. by Jeremy W Couper, Sidney Bloch, Anthony Love, Gillian Duchesne, Michelle Macvean and David W Kissane. Medical Journal of Australia 2006; 185 (8): 428-432.
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