Approximately 1 in 8 men in the United States will be diagnosed with prostate cancer in their lifetime. A prostate cancer diagnosis may stir up many emotions, including anxiety, anger, despair, depression, and hopelessness. Much like when people lose loved ones, patients diagnosed with cancer often go through the stages of grief: denial, anger, bargaining, depression, and acceptance. These stages are an attempt to process change and protect ourselves (and our family/friends) while we adapt to a new reality or new “normal.”
Mental health is how you think, feel, and behave. Importantly, your mental health and physical health are connected—meaning that one can affect the other. Men diagnosed with prostate cancer are at a higher risk of mental health issues, such as anxiety and depression, than the general adult. The mental health effects of prostate cancer can occur for men at many stages along the prostate cancer journey. A man may feel these mental health effects after or because of the prostate cancer diagnosis. He might also feel them throughout treatment and recovery as he adjusts to his diagnosis and living with the side effects of treatment. Importantly, these effects may be there all the time or may come and go. Some will be related to prostate cancer treatments and some may be related to dealing with the diagnosis.
Aspects of treatment for localized prostate cancer that may affect mental health
After the initial shock of a prostate cancer diagnosis, most men with intermediate and high-risk prostate cancer will need to decide on a treatment plan.
Among those men who choose active surveillance and undergo monitoring rather than initial treatment, cancer-related anxiety is quite common. However, many studies have shown that this improves over time. In men where surveillance is appropriate, this choice has not been found to have an increased risk of depression, emotional well-being, or other mental health effects.
Many studies suggest that among patients undergoing surgery or radiation treatment for localized prostate cancer, the side effects of treatment are most likely to affect a man’s mental health. Because of this, it is important to ask your doctor questions about side effects of treatment options such as radiotherapy and surgery. The most common side effects of radiotherapy and surgery are urinary incontinence, erectile dysfunction and bowel toxicity, such as diarrhea.
Although depression and anxiety are more common among men with prostate cancer, treatment choice (i.e., surgery or radiation) doesn’t appear to have a big effect on a man’s chances of experiencing these outcomes. In an important study published at the end of 2021, among 2,072 men with localized prostate cancer, treatment-related regret at 5 years after diagnosis was reported among 16% of men undergoing surgery, 11% of men undergoing radiotherapy, and 7% of men undergoing active surveillance.[1] The study showed that regret appears to be caused by many reasons. It also is influenced by the outcomes of the treatment (cancer control, sexual function, and others) and patient experiences, and how this compares to their expectations about these outcomes. So, more important than the specific treatment you choose is the process of getting there. This study highlights the importance of understanding the side effects of each treatment approach and asking your doctor questions so that you have a full understanding of the treatment plan and potential side effects before treatment begins.
Aspects of treatment for advanced prostate cancer that may affect mental health
The backbone of treatment for advanced prostate cancer includes androgen deprivation therapy (ADT), which reduces testosterone to very low or “castrate” levels, thus removing the “fuel” for the prostate cancer cells. There is a complex signaling pathway between parts of the brain, the pituitary gland, and the testicles that leads to testosterone production. This pathway may be disrupted by medications that affect the signals between the brain and pituitary gland – these are groups of medications called GnRH (LHRH) agonists or antagonists. ADT may cause many effects on your body, many of which may have direct or indirect effects on your mental health. A lot of men experience hot flashes, much as women do when going through menopause. Fatigue is also common as is a loss of libido, or sexual interest. Over the longer term, ADT can lead to depression and perhaps early dementia. Long-term use can also affect your body’s composition by increasing body fat and decreasing muscle mass. It is important to know about these side effects, understand that they are expected, and find ways to combat potential effects on mental health. Most men find that a regular exercise routine, particularly when on ADT, helps to improve their mental and physical health.
What to do if you are depressed or have thoughts of hurting yourself
If you are feeling depressed, it is important to talk to your doctor. Prostate cancer visits with your doctor at the time of diagnosis and during follow-up should include questionnaires or forms to screen for anxiety, depression, despair, thoughts of suicide, and other mental health effects of prostate cancer. Regardless of the screening results, you should mention to your physician if you feel mentally unwell. Cancer centers have specialists (such as psycho-oncologists, psychologists, and psychiatrists) who are experts in treating these symptoms and your doctor can make a referral. If you are feeling like hurting yourself, you should seek help right away regardless of the time of day or night. Reach out to friends, family members, your doctor, and/or the National Suicide Prevention Lifeline, which is available 24 hours/day at 1-800-273-8255 in several languages.
The following symptoms may indicate mental health concerns that you should consider discussing with your doctor:
- Feeling sad or depressed
- More tired than usual
- Lack of motivation
- Having mood swings
- Abnormal changes in appetite (increased or decreased)
- Trouble coping with daily problems
- Sleeping more or less than usual
- Disconnecting from family, friends, and/or co-workers
- Loss of interest in activities that typically are joyful
A prostate cancer diagnosis can be a life-changing event in a man’s life. It is important to know that your feelings about prostate cancer are valid. Feeling stressed, anxious, or depressed when you’re dealing with a new diagnosis or side effects of treatment is normal. You don’t need to feel guilty or ashamed to ask for support. In fact, doing so demonstrates great insight and bravery.
References:
[1] Wallis C JD., Zhao Z., Huang L-C.et al. Association of Treatment Modality, Functional Outcomes, and Baseline Characteristics With Treatment-Related Regret Among Men With Localized Prostate Cancer. JAMA Oncol. 2022; 8(1):50-59.