The “Complication” That Dares Not Speak Its Name

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All serious illnesses cause emotional distress. But prostate cancer patients may be even more vulnerable. This is because treatments for PC often cause erectile dysfunction (in at least 50% of men who’ve had RP, for example), which is highly correlated with depression. Also, some men who’ve undergone treatment have been left with distressing side effects like penile shrinkage or Peyronie’s disease (curvature of the penis). Finally, ED *can and does* cause serious damage to patients’ relationships.

Incontinence, another common side effect of PC treatment, is no fun either.

A number of studies have shown an association between PC diagnosis/treatment with depression and risk of suicide, although I have to stress that MOST men who’ve been treated for PC go on to do fine.. They do not suffer from clinical depression.   But if you look at certain online PC listervs that deal with emotions and intimacy, you will find that the “misery index” is stratospheric among SOME patients who’ve been treated for PC and/or their partners. They are not the majority, but I think their numbers are significant. I realize that these forums are biased, but anecdotal evidence does means something.

So it’s striking to me that the upcoming “Duke Prostate Cancer Symposium“, which features a “Patient Day”, lists two speakers who will discuss patient “quality of life” most directly — and both are urologists/oncologists. There is not a single psychiatrist, expert in sexual medicine or relationship counselor on the panel. I believe these are the people who can help most with improving the long-term quality of life of men who’ve had PC treatment. They should be an integral part of the PC treatment team. If this isn’t possible, the doctor who treats the cancer should give the patient information about ALL potential side effects and appropriate referrals for follow-up.

I will mention that the Duke Symposium will include a talk by a urologist/oncologist about the sexual complications of PC treatment. I’m sure most of it will be about plumbing. But the doctor does mention a study which is looking at sildenafil (Viagra) as a potential treatment for men with ED and depression. But another urologist/oncologist, whose topic is quality of life among men who’ve been treated for PC, has written almost exclusively about the problems of men who are poor or uninsured. Her focus is economic.

I think the primary doctors who treat PC don’t want to discuss consequences like depression, impotence or ruined relationships either because they’re in denial or they just don’t want to say out loud that these things exist. The problem is that the rest of the world knows and is apparently bothered by it. People from various backgrounds and disciplines oppose PSA testing because they believe that the treatments for PC cause more harm than good, Unfortunately, many lives are lost because of this opposition to screening.

One solution to silence the critics would be to do no harm in the first place, i.e., avoid aggressive treatments when there are reasonable alternatives like active surveillance. But so far this is not happening. Another possibility would be to *mitigate* the harm by providing men who’ve had PC treatment with proper support and follow-up. That’s what I’m talkiing about.

It’s very frustrating to me to see that so little progress has been made on this important issue and that so few advocates seem interested.

By | 2017-10-19T10:57:13+00:00 August 14th, 2008|Healing the Mind, Healthcare and Ethics, Key Post, Op-Ed/Inside Scoop|2 Comments

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  1. Jerry Perisho August 15, 2008 at 12:25 am

    Hi Leah. Thanks for your thoughtful comments. I am a man with prostate cancer. My prostate was surgically removed and I followed surgery with chemotherapy and hormone therapy. I agree wholeheartedly with your opinions that more attention needs to be paid to the emotional side of this dreadful disease and its treatments. Why doesn’t it get more attention? I think there are 2 parts to the answer. First, prostate cancer, because it deals so closely with male sexuality, is still talked about in whispers in many circles. That is improving, but prostate cancer and the side effects of treatment (impotence and incontinence) are still discussed in hushed tones. That has to change. Secondly, men simply are not as good as women at dealing with their emotions. We are told as boys not to cry, to “suck it up”, to “play with pain”. It is tough to change those attitudes as you age.

    I believe that if a man can make some emotional growth and realize that there is far more to life than simply being a young stud, then he can appreciate all of the small pleasures that life has to offer and relationships can continue to flourish.

    I am a comedy writer. My book, “I Barf, Therefore I Am: A Sensitive Comedy Writer’s Relationship with Cancer” describes my own struggles and my own growth during recent times as I have dealt with prostate cancer. Thank you for bringing this very important topic to the world’s attention and for your excellent and informative website.

  2. Bob Dahl August 17, 2008 at 2:16 pm

    I had my prostate out almost 3 years ago at the Univ. of Minn. You are right, almost no preparation for problems with “plumbing & heating” following treatment. I have followed up with the specialists that deal with these problems and have concluded after my own research that there is a great deal of ignorance among those MD’s who are purported to be “experts”. I hate it when I ask a pertinent question and just get a vague answer!

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