UICC World Cancer Congress 2006

Prostate cancer is the most common male cancer and second most common cause of cancer death in the Western world, excluding non melanoma skin cancer. Improved survival from prostate cancer has been demonstrated worldwide such that around half of all newly diagnosed men are predicted to be alive 15 years after diagnosis. Thus the number of men in our community who are living with the consequences of the diagnosis of prostate cancer is increasing and the survivorship issues of this patient group are a priority health care issue.

The experience of the diagnosis and treatment of cancer is a traumatic life event for most people. The diagnosis of cancer threatens the individual's survival and future hopes, sense of self, and relationships. Fears about cancer recurrence and uncertainty about the future are common, as are concerns about the physical effects of treatments and disturbances in self image, intimacy and sexuality. The impact of the cancer extends beyond the patient to influence the quality of life of partners and families as well, such that many partners report higher levels of distress than do the men themselves.

In this regard, although men tend to report low psychological distress after diagnosis, a substantial subgroup, up to 38% of men, are highly distressed. One third of men report unmet needs for support about sexuality, psychological distress and treatment information up to five years after treatment. Many men report longer term decision related distress and decision regret is associated with poorer quality of life after treatment. Problematically, men are generally disinclined to seek help for psychological distress and are consistently under-represented as clients to cancer support services. Psychosocial interventions such as psycho-education and peer discussion, peer support, uncertainty management, symptom management; cognitive behaviour and stress management have been found to be helpful to men with prostate cancer with regards to: more stable employment, less sexual bother, improved general QOL and perceived stress management skills, improved uncertainty management, cognitive reframing and problem solving, and continence management and less cancer worry, and decreased social isolation.

Deficits in research to date about the best ways to promote men's adjustment include the failure to target men at the point of highest distress and greatest need; to include sexual adjustment as a key outcome; and to use longitudinal designs with longer term follow up. A large scale study, ‘Proscan', is underway in Queensland Australia that will address these issues. In addition, there is considerable heterogeneity in the longitudinal course of adjustment of cancer patients as a whole. Future research should investigate efficient ways to match the level of care provided to patient's level of distress and expressed need.

Prostate cancer is a significant men's health issue about which important policy and funding decisions must be made. The validation of cost effective supportive care services for men with prostate cancer that are easily translated into practice is essential in order to improve men's health and well-being and that of their partners and families.

References

Steginga, S. K., & Occhipinti, S. (2006). Dispositional optimism as a predictor of men's decision-related distress after localized prostate cancer. Health Psychology, 25(2), 135-143.

Steginga, S. K., Occhipinti, S., Dunn, J., Gardiner, R. A., Heathcote, P., & Yaxley, J. (2001). The supportive care needs of men with prostate cancer. Psycho-Oncology, 10, 66-75.

Steginga, S. K., Occhipinti, S., Gardiner, R. A., Yaxley, J., & Heathcote, P. (2004). A prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer. Urology, 63, 751-756.

Steginga, S. K., Pinnock, C., Gardner, M., Gardiner, R. A., & Dunn, J. (2005). Evaluating peer support for prostate cancer: The prostate cancer peer support inventory. British Journal of Urology International, 95, 46-50.