PALM SPRINGS, Calif--Early diagnosis of prostate cancer can be
a mixed blessing, bringing with it not only the chance of cure
but also the psychological distress of choosing between watchful
waiting and treatment, and if treatment is chosen, which treatment,
Andrew Roth, MD, said at the Academy of Psychosomatic Medicine
"There is controversy among oncolo-gists over the initial
treatment offered to men with early prostate cancer, and this
controversy trickles down and adds to the patient's confusion
and distress, making decisions more difficult," said Dr.
Roth, attending psychiatrist, Memorial Sloan-Kettering Cancer
Center in New York City.
Recently researchers at Memorial Sloan-Kettering have shown that
a low-fat diet coupled with vitamin supplements slows the progression
of prostate cancer in mice. "This might give men the opportunity
for more participation in their care," Dr. Roth said. "There
is a lot of excitement among the men in our clinic who see that
they can do something on their own that might possibly slow the
progression of their disease."
Evaluating Psychological Distress
Dr. Roth noted that with more men being diagnosed with prostate
cancer, the psychological issues of this disease are becoming
more salient. Psychiatric interventions that address the emotional
distress and symptom-related issues of men with prostate cancer
can improve their quality of life, he said.
As psychiatric liaison to the prostate clinic at Memorial Sloan-Kettering,
Dr. Roth meets with all new patients, evaluates their psychological
distress, introduces the multidisciplinary concept of addressing
both physical and psychoso-cial needs, and normalizes the concept
of discussing emotional reactions to stress. "The model that
we use in our specialty clinic is one that could be used in primary
care settings as well," Dr. Roth said.
The psychological symptoms reported by men with prostate cancer
include anxiety, anger, and dysphoria. These symptoms may stem
from the patient's concerns about the disease, but may also have
their etiology in either the disease process or the effects of
Although anxiety is expected at crisis points in the illness,
such as diagnosis, treatment selection, PSA monitoring (see box
below), and news of disease progression, it may be a manifestation
of physical symptoms that are not well controlled.