Treating the psychosocial and emotional impact of prostate cancer

It doesn’t take too much reading or direct experience to realize that, to date, we haven’t been very good at meeting the needs of patients with prostate cancer — or their spouses/partners — when it comes to the sociocultural and psychological needs associated with this disorder.

Here are just a few of the more obvious reasons:

  • The primary treaters of prostate cancer (urologists, radiation oncologists, and medical oncologists) have little to no training and/or experience in this field.
  • The often profound sexual side effects of treatment for prostate cancer are embarrassing for many patients and their spouses/partners, and thus difficult (and sometimes impossible)  to admit to and talk about — even to each other, let alone to a third party.
  • The ability to “perform well” sexually in a traditional sense is a defining characteristic of “being a man” in the minds of a large percentage of the world’s male population, and therefore the inability to do so can be devastating to their sense of self-worth.
  • Current health service systems (in most of the world) are not generally well designed to address the sociocultural or psychological needs of either prostate cancer patients or their spouses/partners.
  • Even when such services are available,
    • They may not be covered by health insurance (which is a particular problem here in the US).
    • Many patients (and some partners/spouses) are unwilling to take advantage of such services, seeing the need to do this as an admission of a form of “weakness” unacceptable to many male patients in particular.

All this is a precursor to some relatively brief comments about the existence of a 41-page-long invited editorial by Chambers et al., just published in the journal Psycho-Oncology. Its title is “New challenges in psycho-oncology research III: A systematic review of psycho-oncology interventions for prostate cancer survivors and their partners: clinical and research implications“, and it was brought to our attention by Richard Wassersug, a regular reader of this column who is also a prostate cancer patient and (guess what) “a research scientist  with ~300 publications spanning topics in psychology, anatomy, human sexuality, and prostate cancer”. However, the article has no abstract, so if you really want to read this paper you are going to need to get a copy of the full text for yourself.

Now Richard doesn’t think we all need to rush out and read this 41-page review, but what he did want to bring to your sitemaster’s attention are some comments made by Chambers et al. in relation to the actual delivery of support services of this type (see p. 883 of the actual paper, at the beginning of the Discussion). And your sitemaster thought some of those comments were worth bringing to the attention of his readers too.

We can summarize their comments in this area as follows:

  • “Psychological and and psychosocial intervention can [and does sometimes] improve decision-related distress, mental health, … and health-related [quality of life] in men with [prostate cancer]” and particularly for men with localized forms of prostate cancer. BUT …
  • “The evidence is less clear for the female partners of these men and [for] couples as a dyadic unit” — i.e., for couples who are seen together, as a “couple”.
  • “Couple-focused interventions were the least acceptable approach and almost half the couple interventions produced poorer outcomes for partners” than for the actual patient.
  • “When couple interventions were effective, they improved relationship outcomes for the partner but not for the man; had a positive effect on the partner’s mental health but conversely; improved sexuality outcomes for the man but not the partner.”
  • “No interventions improved sexuality outcomes for female partners.”

Perhaps this is not entirely surprising, and maybe we should have known better anyway! Men are “from Mars” and women are “from Venus”. It would need a remarkably skilled psychologist to address, successfully, the needs of a man who is largely focused on his inability to “perform” to his own satisfaction in any sort of traditional sense (always assuming that he is even willing to accept that his distress about that is the real, underlying problem) at the same time as that psychologist is having to try and address the needs of a woman who is focused on one or more of several possible and very different problems:

  • Her partner’s “withdrawal” from almost all forms of physical and emotional “contact”
  • Her partner’s near obsession with being able to achieve a satisfactory erection and sexual experience (to the point at which any sense of pleasure for the woman has been completely destroyed because any sense of spontaneity and gratification of her needs has been lost)
  • Her own sense of loss of the physical pleasure of sexual intercourse
  • Her partner “blaming her” in some way for the problem

(If you’ve never done so, just glance through the Ask Amy column on this web site to get a clear sense of the spectrum of problems that many female spouses and partners deal with.)

As an aside, we should be clear that we don’t really know to what extent these conclusions spill over into the world of gay and bisexual couples. As Chambers et al. are careful to point out, research to date doesn’t include enough data for these groups of men. And just as importantly it doesn’t include enough data for men with advanced prostate cancer, or for men from socio-economically deprived backgrounds, or for men who don’t have a primarily Anglo-Saxon background (since most research in this area has been done in places like Canada and Australia and the UK).

What’s the fundamental takeaway? Bluntly, we need to really re-think the entire process of sociocultural and psychological support for men with forms of cancer (and particularly prostate cancer) that significantly impact their ability to “perform” in traditional sexual ways — as well as for their spouses and partners. We are all aware that the consequences can be devastating for all too many couples. It’s time for a serious re-think!


6 Responses

  1. Reblogged this on littledeer74.

  2. I feel like the emphasis on men being disappointed in their “inability to perform” isn’t completely accurate. For both men and women there can simply come a point where the sex you can have just isn’t fun or enjoyable. For some men who have complete ED, dry orgasms, orgasms with urination, penile shrinkage, low or no libido … well, things just don’t feel enjoyable, and it becomes more work than is worth. There don’t even have to be feelings of inadequacy involved. For female partners oral sex in these circumstances gets old fast. (I’m just being honest here.) And yes, a man can pleasure you manually or orally, but frankly, when you can’t return the enjoyment it gets to be not much more fun than a vibrator. Mostly, it feels like the whole thing is just ruined and can’t be fixed.

  3. “Bluntly, we need to really re-think the entire process “. Strongly agree.

    Even a worthy attempt like this starts on the wrong foot. “Survivors” of prostate cancer are people who die of something else. The whole treatment paradigm is based on that hope, on the basis that dying of prostate cancer is (as it undoubtedly is) exceedingly unpleasant. I won’t go on. But how about someone makes a start on “castration resistant”. C’mon people, and you wonder why people like me sit crying on the sidelines hoping for a heart attack.

  4. Dear bgollum:

    Respectfully, “survivors” of prostate cancer are those still alive after a diagnosis with prostate cancer (whether they got treatment of any type or not and regardless of what they may died of in the end). A vast range of those patients suffer from severe and debilitating psychosocial problems.

    I respect the fact that the problems of men who have CRPC have their own set of rather more imminent issues to deal with, but I don’t think we should be diminishing the problems of those who may have to live in fear of dying of prostate cancer for another 30 years.

  5. You misunderstand me and in fact we agree. I am one such and I will never be a “survivor” in the sense of being rid of the fear that it is still there.

  6. Then I apologize for the misunderstanding.

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