Anxiety, Depression in Prostate Cancer: Managing Psychosocial Effects in Male Patients

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Although prostate cancer is highly treatable, men with prostate cancer frequently experience significant anxiety and depression.
Although prostate cancer is highly treatable, men with prostate cancer frequently experience significant anxiety and depression.

A person receiving a cancer diagnosis is likely 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 affect a patient's emotional state. A logical conclusion is that men with prostate cancer — which is generally regarded as highly treatable — would suffer a relatively lower rate of psychosocial distress than 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 men with prostate cancer regarding their feelings of anxiety and depression: 77% of the respondents said they experienced symptoms of anxiety or depression following their diagnosis; 94% thought feelings of anxiety and depression were normal for patients with prostate cancer; and 97% felt there was a need to help patients recognize the symptoms and find treatment.

Men tend to avoid seeking help for psychosocial issues — notably more than women. This is borne out by survey results that suggest men with prostate cancer would benefit from support groups, yet they seldom attend them.1 Other data show that women outnumber men by 3 to 1 in cancer support groups.1 There are myriad reasons for this.

PERCEPTION OF WHAT IS A MAN

Typical qualities that define the role of a man in society are the projection of power, physical strength, dominance, control, and toughness. Neediness or asking for help are considered signs of weakness. Men do not like to appear emotionally vulnerable; instead, they often expect that the task of 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 informational — rather than emotional — support.

Because prostate cancer affects the reproductive, urinary, and gastrointestinal systems, there are often feelings of embarrassment and shame attached to this diagnosis. Already feeling shamed by his status as a patient (and therefore in a weakened state), adverse effects such as incontinence and erectile dysfunction may exacerbate a man's anxiety over future levels of functioning in these areas. All of these factors may lead a man with prostate cancer to hide his feelings even more deeply from medical staff and to refrain from divulging his feelings to his family and loved ones.

Clinicians need to create an environment where men feel comfortable sharing their concerns. One way to do this is to simply reassure a man with prostate cancer that feeling a certain amount of anxiety and sadness is normal, and these feelings can be mitigated by psychosocial support such as counseling and support groups. In addition, study data have shown that patients who receive strong emotional support may benefit from a protective effect on health outcomes.3 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 altogether. 

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