Psychological distress after prostate cancer treatment

Men treated for prostate cancer have high levels of psychological distress and many experience continuing sexual dysfunction and lower urinary tract symptoms, according to a survey of men in England designed to explore their supportive care needs.

Prostate cancer is the most common solid cancer in men, accounting for one in every four cancers diagnosed in males in England in 2004. Fortunately, the survival rate is improving, reflecting its slow-growing nature and its successful treatment in many men. Nearly three-quarters (71 per cent) of men are still alive five years after being diagnosed with prostate cancer.

Therapeutic options include surgery, radiotherapy and hormonal treatments, with the choice determined by the patient's age, cancer stage and comorbidities. Some treatments can have long-term effects on sexual and urological function.

The primary aim is to optimise cancer control, but some doctors take into account the patient's urological and sexual function before treatment and their views on the balance of treatment efficacy against side-effects.

In this study, researchers surveyed men with prostate cancer in six areas of England. They invited 1,848 men diagnosed with prostate cancer in the previous three to 24 months to take part. Those who replied (820) were sent a postal questionnaire asking about supportive care needs, prostate symptoms, quality of life, their cancer and its treatment; 741 were returned.

Three-quarters of the men taking part in the survey were aged 65 years or more; 51 per cent had hormonal therapy, 25 per cent, radical prostatectomy, and 28 per cent, radiotherapy to the prostate. Just under half (46 per cent) of the men said that their cancer was in remission.

The survey revealed that these patients had significant unmet supportive care needs. The areas of greatest need were related to psychological distress, problems with sexuality and the management of enduring lower urinary tract symptoms.

Men who were uncertain of their remission status had higher levels of psychological need, while those not in remission were more likely to need information. Nearly 30 per cent reported moderate or extreme anxiety or depression. A similar number had difficulty with undertaking usual activities. Pain was reported by 26 per cent and 22 per cent had mobility problems.

Virtually all (97 per cent) of the men reported that in the month before the survey, they had experienced lower urinary tract symptoms, including frequency or needing to urinate at night. Urinary symptoms were affected by treatment, remission status and time since last treatment. They were least severe in men who were in remission, in those who had undergone radical prostatectomy and/or in those who had completed their treatment 19-24 months before the survey. Unmet needs related to sexuality were more common in younger men and in those who had undergone radical prostatectomy.

The researchers concluded that the need for systematic assessment and better management of psychological distress in men with prostate cancer was evident, with high levels of distress identified in the sample, even though the majority had completed treatment more than a year ago. They added that sexual dysfunction and lower urinary tract system symptoms also required greater attention by prostate services.

Ream E, Quennell A, Fincham L et al. Supportive care needs of men living with prostate cancer in England: a survey. Br J Cancer advance online publication 2008, 1-7, doi:10.1038/sj.bjc.6604406

Originally published in the June 2008 edition of MIMS Oncology & Palliative Care.

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