Psycho-social and emotional aspects of prostate cancer

I read a lot about men's concerns over the consequences of prostate cancer (PCA) and naturally most of it focuses on the life changing aspects, the physical treatment, ED, incontinence, changed bowel habits, loss of libido and so on. Perhaps it's because we're men that a lot is unsaid particularly about the psychological and emotional roller coaster it puts you through.

For example, if you talk to women about their experience of "female" cancers their emphasis is more about changed body image, flatter chest, hair loss etc. Not so much in men. You hear of women wearing wigs after chemotherapy, but men? That's OK because the body image aspect of women's "self concept" is dominated by appearance, whereas in men, it's dominated by "function", I.e. what we can DO. Perhaps that's why, after treatment for PCA there is so much concern about changed physical function.

Another aspect of experiencing PCA or any cancer is "bereavement", "loss", or "mortality" . I confess to experiencing most of the classic phases of bereavement as described by Kuhbler-Ross, anger, denial. depress, bargaining and the harder one to achieve, acceptance. (There is a difference between acceptance and resignation).. There also the profound sense of injustice, why's this happening to me? What have I done to deserve this?

Mortality is the thing! In the UK 10,000 men die each year from PCA, it is the main cause of premature death in males. More women now survive breast cancer than men PCA.

It still seems we are reluctant to talk about these emotive aspects, except when, occasionally, they erupt.

Perhaps it's because that the nature of men, perhaps it's because of social values, perhaps it's because we're older men raised in a particular culture. Perhaps it's part of our self concept and hence our self esteem that men "deal" with these things and to talk about them or seek help with them is not being STRONG.

Paradoxically, I've found talking about the psychological and emotional aspects of PCA, or anything, to be a positive way of dealing with things and the ability to do so is in itself, a real strength.

It's a real shame, I feel, when the term "psychological" is seen as a dirty word or as a criticism, or that we are not strong, not a fighter, not a real man. It's a shame when counselling is seen as some sort of punishment or as an admission of weakness. It's a shame when "psychological" is associated with certain medical practitioners who are often seen as some kind of demonic or perverse trickster who passes moral judgement on people. Mental health seems still to be stigmatized and actually, mental ilness is not the same creature as psychological well being.

A lot of this comes down to our "state of mind", not just what we're thinking, not just passing moods, but how we see ourselves, how we see the world and the values we put on what we see.

At the end, we can try to deal with consequences of PCA and it's treatment, but part of that might be psychological. Sometimes we won't be able to get the outcome we want and in that case it's better to try to find positive acceptance rather than bitter resignation. That'll psychological too!

[Roger2Dodger]

If your treatments put your cancer in remission,and saved your life, then going forward that would be the most positive thing in ones life. Yes, there are side effects after treatment of PCA, but you just deal with them, you have no choice. Then that's just my opinion.

[Hidden in reply to Roger2Dodger]

Hi Roger, yes of course most people try to deal with them. Some deal with them well, others not so well, some not at all well. What makes the difference? Being in remission and getting on with despite some (not so traumatic) side effects is one thing. What about if there's no remission, what if the side effects are devastating, what if you're dealing with it in your own. What if you're not kin your own but the way you deal with it (or not) affects those around you. Besides there are broader issues than just "the side effects" to any cancer.

The male thing, just get in with it, deal with it, be strong, js one way of getting through, but perhaps it's not the best way, not the only way AND may not work. It;s probably just a form of denial.

[Roger2Dodger in reply to Hidden]

Hey Tim,

"What if This, What if that"....One is going to have to deal with what ever! No matter what the devastating out come might be after PCA. How you deal with it is a personal choice. OR you can set around a whine about it all day long. Or like one reply said "take out a shotgun" There is help out there to deal with what ever the after effects might be after PCA. You misunderstood me on dealing with it, dealing with it means getting help for what ever the issue might be. And yes, be strong and show some intestinal fortitude when however you deal with it. It's not necessarily the man thing, you can get help dealing with the issues. The fact remains we are victims of prostate cancer and we have no other choice but to meet the demands of side effects or what ever comes along. And I do not see it as denial, I see it meeting the issues with what ever course of action one takes, not going alone, but seeking help and advice.

[dentaltwin in reply to Roger2Dodger]

When I first started having depression and anxiety, my kid brother facetiously told me to "walk it off".

It's not a matter of "manning up". Depression is not a choice. That this seems so poorly understood is demonstrated every time a celebrity with "everything to live for" offs him/herself and people react in disbelief. It takes a certain amount of self-awareness that one needs help--and then that help has to be available and affordable.

Answering that stigma--that admitting you need help doesn't make you a weak sissy--will help a lot of people.

I have no argument with your statement that we must deal with the downside of prostate cancer treatment.

[Hidden in reply to dentaltwin]

I agree, the admission is a strength not a weakness.

[dentaltwin]

Very good points. As someone who's been treated for about 20 years for anxiety and depression, I agree that the stigma of mental illness has caused enormous harm. In the U.S. insurers have been mandated to cover treatment for mental illness at the same level as for other illnesses, but from what I've read they have lagged. There is increased lip service paid with the opioid epidemic, and every time we have (another) mass shooting, or another celebrity suicide--but nothing really changes.

Thanks for posting!

[Hidden]

Pretty much the same in the UK. There's lots of political words flying around about mental health being provided on a level with physical health provision. Not much change apparent as yet. Meanwhile, the need for mental health services is increasing due to the wider recognition of problems in our young, the increasing number of older people and loneliness.

It's a social phenomenon. The way society has become in the last few decades is possibly the root of the problem.

Unfortunately, stress, anxiety and depression can leave you vulnerable to other health problems, such as cancer.

I have had the good fortune to have some help from a couple of fabulous charities since I was diagnosed with PCA

These have very much supplemented, the national health service provision.

Medical insurance here is probably different to the U.S.. The NHS is paid for from tax income. The majority of people aren't willing or able to pay on top of taxes for additional "private" health insurance. I believe private insurers aren't under any mandate. Mental health issues aren't profitable! Nor is dementia, or cancer so private insurance is probably poor in covering those.

They usually won't cover "pre-existing" conditions so by the time you realise you need the cover, it's too late.

Having said that, the UK NHS is very good at early diagnosis and treatment of cancers. More people are surviving. However that means more people are left in a vacuum after treatment ends and they are "living with and beyond cancer" (LWBC)

A lot of the challenges of LWBC are psychosocial as well as physical or fnancial

Since being diagnosed with PCA I have actively pursued organisation that offer psychosocial support, but I did that before anyway. It just became more pertinent.

[dentaltwin in reply to Hidden]

I'm pretty early in the process (my catheter is scheduled to be removed this Thursday--YAY!), and I have a pretty good bunch of family and friends for support. I'll also doubtless lean on you and others with more experience as a sounding board and for advice. I'm now on Medicare, which so far is reasonably liberal with coverage. I know that could change under the current political climate. Thanks for your thoughtful posts.

[cpcohen]

There are three worthwhile books by Anne Katz, PhD (nursing), that have a lot of good material on the psychological impact of cancer (in general) and prostate cancer (in particular):

. . . "Woman, Cancer, Sex"

. . . "Man, Cancer, Sex"

. . . "Prostate Cancer and the Man You Love: Supporting and Caring for Your Partner"

As someone who _thought_ he was prepared for the emotional impact of ED, I sympathize with most people in this thread:

. . . We should be doing a better job in counselling men, and women, about how they're

. . . likely to _feel_ (rather than what they're likely to be able to _do_) after diagnosis

. . . and treatment.

>>>

. . . Yes, there are side effects after treatment of PCA, but you just deal with them, you have no choice. . . .

>>>

That's logically correct -- but some people "just deal with them" way better than other people. Some people deal with them by going into depression, and some might deal with them by breaking up a marriage, or taking out a shotgun.

We (especially the docs) should be doing more to help men (and women) in this journey.

. Charles

[Hidden]

Thanks Charles, I have heard of Anne Katz.

Yes there's different kinds of "dealing", as you identify.

Some of which I'd call maladaptive.

[Vitruviusman]

I had my surgery in 2010. I have not had a date in over 6 years which also means no sex in over 6 years. Once it is made known, my cock does not get hard, it ends the conversation. The author of this article is correct, "WE MEN ARE JUDGED BY WHAT WE CAN DO!" forget about the political corrective crap. It comes down to this: NO DO. NO DATE. End of story. Needless to say, I feel chronically depressed and sad. No one said having PC would also be equated with loneliness. For those we are married and have wives/or sig others that are "understanding" you stand a better chance of escaping the loneliness. For those of us we are single and/or our wives/sig others left us because of it, we are left in the dust. None of the ED drugs work and the implant sounds horrifying.

[Hidden in reply to Vitruviusman]

Sorry to hear your plight. I can sympathise. I wasn't married when I had surgery and although I was in a relationship at the time, it fell apart. I've got married since, but I don;t think it would have happened if I hadn't recovered erectile function.

Your situation does highlight the pyscho-social consequences of PCA not just the physical.

One of the things many people say about having cancer or having survived cancer is that they feel alone with it. You are literally alone. I am actually involved with an organization who's motto is, "you don' need to be alone"

I don't know if there is an equivalent in the US. You may also find that there are support groups who might be helpful.

[speedyhaddock]

Well said Tim ------ as all of your responses the voice of informed reason from some one with good personal knowledge and also having gone through the Pca mill