Counseling the Client With Prostate Cancer

Prostate cancer is an inglorious disease, rife with indignities that cut to the core of male sexuality and self-esteem. (Brink, 2000) Prostate cancer has received increased attention in the United States (U.S.) because of the significant number of newly diagnosed cases and increasing numbers of resulting deaths. The number of men newly diagnosed with prostate cancer each year will exceed 180,000 (American Cancer Society, 1999). Beginning in 2000, the number of annual U.S. prostate cancer deaths will have exceeded 31,000 (American Cancer Society, 1999). For a comparison, the cases of newly diagnosed prostate cancer are relatively similar in number to newly diagnosed breast cancer cases, 180,400 and 182,800, respectively. Related to the increased prostate cancer diagnoses and deaths is the increased life expectancy of men. Prostate cancer is most often first diagnosed when men are in their 60s (Litwin, 1995), and as the disproportionately large baby boomer generation ages, many more men will be at risk. Because of the prevalence of prostate cancer and the concerns resulting from this deadly disease for clients and their partner (e.g., sexual dysfunction, financial strain), counselors must be aware of problems and needs that are typically presented. DEVELOPMENTAL AND CANCER-SPECIFIC ISSUES OF CLIENTS WITH PROSTATE CANCER During their mid- to late 60s, men are actively reviewing past personal successes and failures and struggling to define "post-career meaning" in their lives. This stage of life, often referred to as late adult transition, is described by Levinson (1978) as "a period of significant development and represents a major turning point in the life cycle" (p. 62). Those who successfully navigate this transition reach what Erikson (1963) defined as ego integrity, a point where past successes are recognized and failures are accepted. Those who fail to see the value of the many trials and successes in their lives find themselves in a state of despair. The place where older people find themselves on the continuum of integrity and despair is largely the result of how they manage retirement and confront death (Sinick, 1980) and cope with the numerous stressors of late adulthood (e.g., loss of significant others, declining physical abilities and finances; Blum, 1990; Duffy & Iscoe, 1990; Myers, 1990; Sharp, Blum, & Aviv, 1993). According to Sinick (1980), men's attitude toward retirement can vary from excitement to dread. For some men, retirement is the opportunity to devote more time to their interests, and thus it can be a period of substantial creativity and productivity. Concurring with this, Levinson (1978) suggested that some men have produced their best work in their 60s and 70s (e.g., Freud, Jung, Picasso, Tolstoy). For other men, retirement creates a sense of emptiness and loss, and, oftentimes, this feeling is even more pronounced when they have been forced to retire. Because society places so much value on work, older men often experience a perceived powerlessness shortly after retirement. Hence, if this developmental issue is not successfully navigated, older men can become overwhelmed by despair. Confronting death is another significant issue during this developmental stage. Sinick (1980) stated that older people's reaction to their own death "range from anxiety and numbness to finely shaded differences between accepting to the inevitable" (p. 152). Erikson (1963) suggested that failing to accept one's life will exacerbate the fear of death. Invariably, a cancer diagnosis causes people to face their own mortality rather abruptly and decreases the opportunity to work through unfinished business and, then, possibly ease into acceptance of death. For some people, a cancer diagnosis gives their lives clarity and meaning by waking them from trivial concerns (McQuellon & Hurt, 1993), while many others experience nothing short of a crisis (Lewis, Gottesman, & Gutstein, 1979). …