The Challenges of Prostate Cancer: A Major Men's Health Issue

In this paper we provide an overview of prostate cancer prevention, detection, treatment, and quality-of-life issues. This review indicated that surgery, radiation, and hormonal treatments are frequently administered to patients and are often associated with incontinence and impotence. However, little is known about subjective, qualitative, and positive aspects of prostate cancer survivorship. We conducted a study to assess areas of personal growth and changes in philosophy of life. Survivors were also asked about the most important way their lives have changed since their prostate cancer experience. Many men reported positive changes in their philosophy of life and that they had adopted healthier lifestyles. However, others reported diminished sexual functioning that has negatively impacted their lives. We conclude that a diagnosis of prostate cancer may provide long-lasting positive, as well as negative, side effects. Key Words: prostate cancer survivors, prostate cancer treatment options, physical and psychosocial side effects of prostate cancer treatments, developmental changes in prostate cancer survivors Prostate cancer is the most commonly diagnosed cancer in the United States, with an estimated 198,100 new cases expected in 2001 (ACS, 2001). More than 86 men die from prostate cancer daily (31 ,500 annual deaths), second only to lung and bronchus cancer as a cause of cancer death (ACS, 2001). Direct costs of prostate cancer in the U.S. have been estimated at $4.7 billion annually, a figure that does not include indirect costs associated with lost workdays, reduced productivity, and unpaid caregiving (Brown & Fintor, 1995). While prostate cancer is diagnosed in men in all ethnicities and races, African-American men have substantially higher incidence and mortality rates than other groups (Ries et al., 2000) (Table 1). In fact, prostate cancer mortality rates for African-American men are the highest in the world (Brawley, Knopf, & Merrill, 1998). If a man lives long enough, developing prostate cancer is almost a certainty. Pathologic examinations based on autopsies have demonstrated that by age 75, 50-75% of men have histological evidence of prostate cancer (Brawley et al., 1998), and an estimated 90% of men older than 90 years are affected (Garnick, 1994). Many of these men may not know of their prostate cancer, since it is often indolent, slow-growing, and presenting few if any symptoms (Brawley et al., 1998). With the advent of a simple blood test to measure the amount of prostate-specific antigen (PSA), a protein produced by the prostate cells, it has become possible to detect prostatic abnormalities, even in the absence of clinical changes. Due to the availability of PSA examination, increasing numbers of men have been diagnosed and treated for prostate cancer in the past decade. Incidence rates rose rapidly in the early 1990s when the PSA tests first became widely used (Potosky, Miller, Albertsen, & Kramer, 1995) and have declined since then (Legler, Feuer, Potosky, Merrill, & Kramer, 1998). However, with the aging of the U.S. population, the numbers of cases of prostate cancer are likely to increase in the near future. Most men diagnosed with prostate cancer will live for a considerable length of time after their diagnosis. For example, most prostate tumors are diagnosed at an early stage, when the tumor is small and has not spread to other parts of the body. Men with such localized tumors will almost certainly not die of prostate cancer within the next five years; their relative survival rate is 100% (ACS, 2001). Even considering all stages of prostate cancer, 72% of men live at least 10 years after their diagnosis. Nonetheless, the treatments for prostate cancer -- surgery, radiation, and/or hormonal therapy -- are associated with considerable morbidity, both long-term and short-term. Given that prostate cancer survivors live with these sequelae of the disease and treatment, understanding effects of prostate cancer on their daily functioning, or quality of life, is an important consideration. …