The authors challenge the notion that men with prostate cancer exhibit little psychological difficulty. In fact, we do not know much about actual distress rates in men with prostate cancer because few studies have directly measured distress in this population. Likewise, we do not know if the distress experienced by prostate cancer patients is qualitatively different from that of other cancer patients. By assuming that all men with prostate cancer "do well," we, as clinicians and researchers, may fail to ask patients important questions.
Screening and assessment for distress should be a standard part of all physician and clinic visits. Of primary importance is helping patients to understand the difference between a more normative, short-lived distress and a more enduring, impairing psychological disorder. Often, it can be comforting to a patient to know that what he is feeling is experienced by others in his situation. It is also important that a patient understand that his feelings may be exacerbated by his medical regimen (eg, the influence of steroids on sleep problems). As the authors point out, clinicians need to recognize the interplay between medical and psychological symptoms, especially for patients undergoing active treatment.
The Cancer Experience
The cancer experience (diagnosis, treatment, and recovery) can be construed as a traumatic event. Most patients feel some level of distress and experience a host of emotional reactions as they attempt to "make sense" of the trauma. Such feelings are a normal part of the cancer experience. It is important to inform patients about the normative and often predictable reactions to the cancer experience, from feelings of anxiety and/or depression at the time of diagnosis and treatment decision-making, to the bothersome effects of curative treatment on urinary, sexual, and bowel function. However, clinicians should remain vigilant to those whose feelings of distress do not diminish with time and/or worsen into a psychological disorder.
Implicit in Pirl and Mello’s discussion is the notion that the health-related quality of life and distress of prostate cancer patients differs between those with early- and those with advanced-stage disease. Several studies have illustrated considerable differences in the experience of these two groups. Different treatments often produce different sequelae, with early-stage patients experiencing more disease-specific complications (ie, urinary, sexual, and bowel problems), and advanced-stage patients experiencing more of a broad spectrum of complications (ie, pain, fatigue, appetite/weight problems, emotional problems). Hence, different therapeutic approaches may be necessary for early vs advanced-stage patients.
Emotional reactions to prostate cancer have several unique features that warrant highlighting. As this is an entirely male disease, adaptation may vary based on differences in male communication styles, need for control, and willingness to ask for help. Also, many men with prostate cancer are older and present with other debilitating comorbid conditions that may complicate both their physical and emotional presentation. Finally, for many early-stage patients, there is no definitive "best" treatment, which adds to the anxiety that patients often experience in those early weeks of diagnosis and treatment decision-making. Certainly, the severity of the disease, premorbid psychological functioning, and social support all play important roles in psychological reactions to the cancer experience.