by Dr Kenneth Gannon, Clinical Research Director, University of East London.
This year two reports appeared that demonstrate the impact of prostate cancer on men. Data from Prostate Cancer UK revealed that it has become the third most common cause of cancer death in the UK, with almost 12,000 men dying from it every year. Strikingly, more men now die from this disease than do women from breast cancer. Separate data from the men’s health charity Orchid showed that over a third of prostate cancers are diagnosed at an advanced stage and that over 40% of men with the disease experience delays in diagnosing it. These figures apply to men generally, but there are also important differences between groups of men. The most striking of these is the fact that African Caribbean men have almost a three-times greater risk of developing the disease than white men. They also develop the disease, on average, at a younger age and in a more aggressive form.
Prostate cancer is clearly a very significant physical health issue for men, but it also poses major psychological challenges for them and those close to them. These challenges occur at each stage of the cancer “journey”, from noticing symptoms to undergoing tests through receiving a diagnosis and undergoing treatment to life after treatment.
Prostate cancer is not always accompanied by clear and distinct symptoms and a number of studies have shown that men are, in any case, poorly informed about the prostate itself and the nature and risk of prostate cancer. This means that they are unlikely to be prompted to consult their GP on the basis of clear and well-understood symptoms. The fact that there is no reliable and effective screening tool for prostate cancer, as there is for breast and bowel cancers, compounds this. Men can request a blood test (called the PSA test), which detects the presence of a protein associated with prostate cancer. However, current advice tends to recommend that GPs discuss the costs and benefits of this, largely with the aim of dissuading men from having it, because positive results are not definitive and result in further unpleasant and potentially risky tests such as digital rectal examination and transrectal biopsies. Research indicates that these tests are especially aversive for some groups of men, such as Latinos and African Caribbean men, because of anxieties associating anal penetration with homosexuality.
If testing confirms the presence of prostate cancer men are faced with further difficult and fraught decisions. There is currently no “gold standard” treatment available and what men are offered will depend on the speciality and preferences of the clinician they consult, in addition to objective considerations such as the rate of growth and the clinical stage of the tumor. All treatments entail significant and distressing side effects. Tumors that are confined to the prostate are usually treated with surgery and some form of radiation treatment. These generally result in temporary and sometimes permanent erectile dysfunction and urinary incontinence as well as other effects, including retrograde ejaculation and shortening of the penis. Tumors that have spread beyond the prostate may be treated with drugs aimed at reducing the circulating levels of androgens. These are associated with symptoms similar to the menopause in women along with weight gain and gynomastia.
These side effects have in common the fact that they affect characteristics that, in many cultures and certainly the developed West, are seen as key signifiers of masculinity. For this reason psychologists have drawn attention to the ways in which dominant understandings of what it is to be a man (referred to as hegemonic masculinity) shape men’s response to diagnosis and treatment of prostate cancer. It is certainly the case that very many men struggle to come to terms with the consequences of even successful treatments for prostate cancer. Research has shown that concerns about urinary and sexual function are associated with greater levels of psychological distress. The side effects can be distressing for any man, but often particularly so for African Caribbean and African American men, in part because they are often much younger than white men when they develop the disease and therefore live with the side effects for longer. Interestingly, studies indicate that the female partners of men with prostate cancer report greater levels of distress than the men.
Having started with the bad news about mortality and missed diagnoses it is important to emphasise that the picture for prostate cancer is broadly positive. Treatments continue to improve and survival rates are good. This means, however, that more and more men are living with the side effects described above and many of these men and their partners are in need of support. Returning to the metaphor of a journey, there is a real need for psychological involvement at all stages, from diagnosis, through making decisions about treatment to living as a survivor.
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Dr Kenneth Gannon is the Clinical Research Director and Research Degree Leader at the University of East London. Ken presented his work at the 2015 Male Psychology Conference at University College London (UCL). His book chapter will appear in the forthcoming Handbook of Male Psychology: Theory and Practice (Palgrave Macmillan) in 2019. Contact firstname.lastname@example.org
Prostate Cancer UK (2018). We call on UK to step up as new figures show prostate cancer now a bigger killer than breast cancer. Accessed online 7th May 2018 on the internet [here]