William Pirl and Jeffrey Mello present an informative overview of the psychological impact of prostate cancer. They also provide a practical framework for distress management, as promulgated by the National Comprehensive Cancer Network (NCCN).
By identifying the dearth of psychosocial information about men in general and by suggesting a systematic approach to management, the article can be helpful to the primary oncology team (physician, nurse, social worker) and others concerned about the quality of life of men with prostate cancer. Pirl and Mello cover much ground quickly—distress, depression, anxiety, delirium, interventions, etc—and in doing so are able to create, in broad strokes, a topographic map of the terrain.
First, however, a discrepancy needs to be clarified. Pirl and Mello state, "In fact, one study of many different types of cancer, including prostate cancer, found no differences in levels of psychological distress among patients with different cancers."[1] However, another reading of the abstract cited (Zabora et al, 1996) reveals the following: "The lung cancer group demonstrated a significantly higher level of psychological distress (F = 5.7, P < .001) than the other diagnostic sites with the exception of hepatoma and brain where there was no significant difference." Thus, there are differences in psychological distress levels among groups with different cancers.
Why So Little Psychosocial Information About Men?
Despite the fact that cancer occurs more commonly in men, most of the psychosocial literature has focused on women—specifically and overwhelmingly, women with breast cancer. It is also widely accepted that, overall, men seek medical care less often than women. The lack of information about men’s psychosocial health may be another manifestation of this trend.
Traditional male role, age, race, and sexual orientation are all relevant influences discussed by Pirl and Mello, and the authors are right on target with their exposition. When the age group and common physical symptoms of prostate cancer patients are considered, the influence of the traditional male role is extremely important. As noted by Pirl and Mello, the physical symptoms and loss of control associated with the disease can be humiliating, frequently resulting in a sense of shame, demoralization, and social withdrawal.
The authors do not mention several other relevant factors that merit discussion. To begin with, the health-care system is not friendly to men. Most men (and many women) perceive psychosocial interventions as being overly focused on the extraction of emotions and personal information rather than on solving the myriad of practical problems created or exacerbated by cancer.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
