The Emotional Side Effects of Prostate Cancer

by Joslyn R. Kenowitz, Stephanie Napolitano, and Christian J. Nelson, PhD

Prostate cancer is the most com­mon cancer diagnosed among men. Because of an increase in more effective treatment, the relative five-year survival rate is close to 100 per­cent when discovered in the local or regional stages. However, although survival rates are high, prostate cancer treatment comes with a variety of emo­tional and physical side effects.

Early-Stage Prostate Cancer
Ninety percent of men diagnosed with prostate cancer are diagnosed at an early stage. The most common treatments for this stage include surgery and radiation ther­apy. Although surgery aims to spare the nerves re­sponsible for erections, men report problems with erections up to four years after surgery. In addition, many men experience urinary inconti­nence as a side effect of sur­gery. Radiation therapy can also cause erectile dysfunction, as well as diar­rhea, fatigue, and urinary issues.

In addition to coping with the diag­nosis, men also face psychological difficulties that accompany the physical side effects. Men with erectile dysfunc­tion have more depressive symptoms, as well as frustration, shame, disappoint­ment, and relationship stress. These strong emotional responses can even lead to avoidance of treating erectile dysfunction and reluctance to engage in intimate or sexual situations.

Some men who experience urinary incontinence say that this side effect has a considerable effect on their everyday activities and negatively affects their quality of life. A poorer quality of life can lead to psychological distress, noted by an increase in anxiety, anger, and depression.

Advanced Prostate Cancer
For late-stage prostate cancer, androgen deprivation therapy (hormone therapy) is generally the standard treatment. Hor­mone therapy helps to decrease prostate specific antigen (PSA) levels and man­age disease progression. This type of therapy can also cause a number of side effects, includ­ing hot flashes, osteoporosis, anemia, fatigue, loss of muscle mass, breast en­largement, loss of interest in sex, erectile dys­function, and emotional dis­tress. Many of these side effects may continue to worsen with the length of treatment; in other words, the longer the treatment, the more severe the side effects become.

Some evidence suggests that androgen deprivation may also significantly affect cognition. Several recently published studies indicate that androgen ablation may negatively affect memory, visuo­spatial abilities, psychomotor speed, and executive functioning, which can also lead to an increase in anxiety, depres­sion, emotional distress, anger, and loss of control.

Managing Side Effects
The way you choose to manage these side effects is directly related to how much they will interfere in your everyday life. Many men tend to avoid and ignore the nega­tive emotions associated with a cancer diagnosis and treatment side effects, which correlates to poorer adjustment and greater levels of stress.

Called “wish-fulfilling,” this type of coping often directs cancer survivors’ attention to what could have been, or would have happened, rather than what is happening now. Survivors often get stuck in this cycle of wishing they were feeling differently, rather than actively looking for ways to handle their emotions.

Conversely, researchers have found that information-seeking (an active form of coping) instead of wish-fulfilling leads to better psychological and physical out­comes. When applied to prostate cancer, this approach leads men to gain knowl­edge about the side effects they may encounter and learn how to manage these side effects and reduce their impact on daily activities.

The more informed you are about your illness and ways to manage its side effects, the better chance you have to en­gage in a healthy lifestyle, comply with treatment, and focus on the meaningful as­pects of your life. Confronting is­sues in a direct manner gives you more control and allows you to seek out and use information in a positive and productive way.

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