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.