Psychiatric Times April Bonus Edition 2005 Vol. XXII Issue 5
Prostate cancer is the most common cancer in males in the United States with an estimated 230,000 new cases in 2004, more than 70% of which will occur in men over age 65 (American Cancer Society, 2004). It is the second leading cause of cancer death in men. Prostate cancer incidence rates are 32% higher for African-American men than white men, and the mortality rates are twice as high for African-American men. This is likely because African-American men are diagnosed during later stages of the disease. The psychological reactions of this generally older population of men will depend on available supports, psychiatric history and other significant life events, such as recent death of a spouse, divorce, entering dating situations as older men, retirement or previously losing loved ones to cancer. Roth and colleagues (1998) found that 15.2% of men with prostate cancer met the cutoff for probable case of depression using the Hospital Anxiety and Depression Scale (HADS). They also reported that about one-third of the men experienced significant anxiety. A significant amount of anxiety is also found in men screened for prostate cancer (Cormier et al., 2002).
American Cancer Society guidelines recommend a yearly digital rectal examination along with an annual prostate specific antigen (PSA) test for men age 50 and older (American Cancer Society, 2004). Men who are at high risk, such as African-Americans or those with a strong family history of prostate cancer, are advised to begin testing starting at age 45. Routine screening PSA tests for younger men that have yielded cancer results have led to heightened anxiety and confusion, as there seems to be little consensus about the benefits versus complication ratio for treatment in younger men.
Early Phases of Diagnosis
Apart from the general worries of a new cancer diagnosis, there is still controversy about selection of primary treatments for prostate cancer, making the decision about treatment difficult. Primary treatment options are radical prostatectomy, radiation therapy and "watchful waiting," which can lead to differences in specific areas of functioning such as sexual function, urinary functioning or bowel functioning over time (Table 1) (Penson and Litwin, 2003).
Differences of professional opinion often trickle down to patients, creating uncertainty and making their decision about treatment difficult. Watchful waiting (deferred therapy) is often recommended for those over age 70 with significant comorbid illness, low-grade indolent cancers and <10 years life expectancy.