Pirl and Mello carefully review the current state of knowledge about the psychological complications of prostate cancer. Their discussion is worth reading, particularly by those who treat patients with the disease. To put this knowledge in context for the general reader, we should give some thought to what this review illustrates about all patients with a serious life-threatening illness.
Balanced Treatment
If one considers all of the health care a patient with prostate cancer needs, it can be divided into efforts to fight the disease and efforts to relieve the distress or suffering that are part of the illness experience. Although contemporary oncology tends to focus on efforts to fight the disease, Pirl and Mello point out that relief of distress is also an important component of medical care. The authors focus on psychological distress, but that is part of a larger concept of suffering.
Suffering can be experienced in physical, psychological, social, and spiritual domains. The relative amount of health-care resources devoted to fighting disease and relieving suffering have been described as proportionate to need across the course of the illness (Figure 1).[1] In contrast with disease-focused therapy, a dynamic balance sensitive to the whole person with cancer and his or her unique circumstances is the model for comprehensive cancer care.[1,2] The challenge to the individual oncologist is to have the attitudes, knowledge, and skills that allow him or her to respond, provide therapy, work with colleagues in a team approach, and make referrals when appropriate.
Psychological Distress in Prostate Cancer Patients
These authors observe that 10% to 20% of men with prostate cancer have clinically significant levels of psychological distress. This is commensurate with the levels of psychological distress reported for all patients with cancer and underscores the importance that the general oncologist should place on acquiring the needed information. It also mirrors our experience in caring for more than 3,200 patients each year—the majority of whom have cancer. Patients with advanced prostate cancer do not focus on the loss of sexual potency; they are much more concerned with other aspects of loss that accompany the experience of cancer.
Of interest to those who treat localized prostate cancer with the goal of cure, the authors refer to one study that found differences in quality of life related to the type of treatment used.[3] Given the contemporary understanding that surgery, external-beam radiation, and brachytherapy yield equivalent outcomes in terms of cure, the emphasis on quality-of-life measures to guide decision-making is of particular importance.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
