It is normal for a person receiving a cancer diagnosis to experience a wide range of emotions. Fear, anxiety, sadness, and depression are among the most prevalent. The type of cancer, stage, and treatment modality may all affect a patient’s emotional state. It seems logical to conclude that patients with prostate cancer—generally regarded as highly treatable and the most common type of cancer among men—suffer a relatively lower rate of psychosocial distress compared with people receiving diagnoses that typically have poorer prognoses and outcomes. However, men with prostate cancer commonly feel significant anxiety and depression.
CancerCare and Us TOO International surveyed 633 patients with prostate cancer regarding their feelings of anxiety and depression. Seventy-seven percent of the respondents said they had experienced symptoms of anxiety or depression following diagnosis, 94% thought it was normal for patients with prostate cancer to feel anxiety and depression, and 97% felt there was a need to help patients recognize these symptoms and find treatment for them.
Men tend not to seek help for psychosocial issues and notably less often than women do. This is borne out by survey results that suggest men with prostate cancer would benefit from support groups; however, they seldom attend them, and other data show that women outnumber men 3:1 in cancer support groups.
There are myriad reasons for this. Power, physical strength, dominance, control, and toughness are the typical qualities that define the role of a man in society. For men, neediness and asking for help are considered signs of weakness. Men do not like to appear emotionally vulnerable; instead, they often expect that feeling emotions should fall to a spouse, partner, or relative. Stereotypically, men are expected to be logical and make decisions based on the analysis of information. When they do reach out to their doctors and nurses, it is often for support of the informational, not emotional, variety.
Because prostate cancer affects the reproductive, urinary, and gastrointestinal systems, embarrassment and shame are often attached to this diagnosis. Already feeling shamed by being seen as a patient (and therefore in a weakened state), adverse events such as incontinence and erectile dysfunction may exacerbate anxiety over what a man’s future level of functioning in these areas might be. All of these factors may lead a patient to hide his feelings even more deeply from medical staff and to refrain from divulging his feelings to his family and loved ones.
It is important for clinicians to create an environment where men feel comfortable sharing their concerns. One way to do this is to tell men with prostate cancer that it is normal to feel a certain amount of anxiety and sadness and that these feelings can be mitigated by psychosocial support such as counseling and support groups. Also, study data show that patients who receive strong emotional support may benefit from a protective effect on health outcomes.2 These patients are more likely to follow their treatment plans, whereas patients who are depressed might be inclined to feel treatment is useless or give up on it.
An important first step to helping a male patient with prostate cancer cope with emotional issues is to help him identify his feelings: Determine whether he is experiencing anxiety, depression, or both, and note that anxiety and depression are not the same and may require different interventions and treatments. A certain amount of anxiety occurs in daily life for most people. This “situational anxiety” occurs frequently for patients with cancer before having a medical test like a scan or a treatment like radiation. This is different from pervasive anxiety that interferes with daily functioning and may include symptoms such as gastrointestinal distress, chest pains, elevated heart rate and blood pressure, or suddenly breaking into a sweat.
Depression is a medical disorder characterized by feelings of sadness and a loss of interest in activities once enjoyed, and it may be characterized by hopelessness, despondency, abnormal sleep or eating habits, loss of interest in sex, feelings of worthlessness, the desire to harm oneself, or suicidal thoughts.
Men with prostate cancer may already feel diminished in the eyes of others and, subsequently, may reject the interventions that can help mitigate anxiety and depression. Support groups, individual counseling, or a prescription for anti-anxiety or antidepressant medications may be highly useful, but these solutions are sometimes seen by men as further signs of weakness. Nevertheless, all of these options should be made known to patients with prostate cancer. It can be helpful to reassure men with this diagnosis that their innate distaste for these interventions is normal and to make clear that these interventions are often helpful and may lead to better quality of life and improved medical outcomes.
Andrew Chesler, MSW, LMSW Andrew Chesler, MSW, LMSW, is Men’s Cancers Program coordinator at CancerCare.