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 meeting.
"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 drug therapy.
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.