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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Editor’s Note: Joslyn Kenowitz is a research study assistant, and Stephanie Napolitano is a research study specialist, both at Memorial Sloan-Kettering Cancer Center in New York, NY, where they conduct research on sexuality, cognition, and anxiety in men with prostate cancer. Dr. Christian Nelson is a clinical psychologist with expertise in treating men with prostate cancer and other genitourinary diseases at Memorial Sloan-Kettering.
This article was originally published in Coping® with Cancer magazine, March/April 2012.