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
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). 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 yearthe 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 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. 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.
1. Ferris FD, Balfour HM, Bowen K, et al: A Model to Guide Hospice Palliative
Care. Ottawa, Ontario, Canadian Hospice Palliative Care Association, 2002.
2. Foley KM, Gelband H, (eds): Improving Palliative Care for Cancer: Summary
and Recommendations. National Cancer Policy Board, National Research Council.
Washington, DC, National Academy Press, 2001.
3. Bacon CG, Giovannucci E, Testa M, et al: The impact of cancer
treatment on quality of life outcomes for patients with localized prostate
cancer. J Urol 166:1804-1810,
4. von Gunten CF, Martinez J, Neely KJ, et al: Clinical experience in hospice
and palliative medicine for clinicians in practice. J Palliat Med 1:249-255,
5. CPT 2002. Chicago, American Medical Association, 2002.