2020 prostate cancer awareness month

Removing men’s stigma of prostate cancer

A diagnosis of any type of cancer is unsettling and scary to say the least. But even more concerning is how some cancer diagnoses may conjure certain perceptions or feelings than other cancers. For example, a person who’s received a diagnosis of lung cancer, who also smoked for decades, may evoke stigma from his community compared to another person diagnosed with breast cancer. One type is associated with poor lifestyle choices which may ‘blemish’ the response of friends or family, while the other does not.

Prostate cancer, surprisingly, also has its share of stigma associated with it. It’s not unusual for men given this result to feel shameful or ‘less of a man’ because of the prostate glands function linked with sexual performance and is the organ that produces semen. A man’s self-image often depends on their ability to perform like ‘a man’ and to be virile in their manliness and unwavering in showing emotion.

Besides self-image issues, unfortunately, men with prostate cancer have an increased risk of suicide compared to men without this diagnosis. While survivorship of prostate cancer is high, with 95% of men alive 5 years after their diagnosis, it does not necessarily mean these men are living well. Up to 1 in 4 men experience anxiety and 1 in 5 men have depression after prostate cancer treatment. The more advanced a man’s prostate cancer is, the more distressed they are.

Study finding stigma experienced by men with prostate cancer

A small, qualitative study in Canada set out to evaluate prostate cancer-related stigma and the impact it had on men given this diagnosis. The 11 men involved with the study had completed prostate cancer treatment at least 6 months prior and reported experiencing prostate cancer-specific stigma.

The results of the study found 3 themes that resonated with these men:

  • The men had perceived themselves as less masculine that resulted in each internalizing the stigma or shame ultimately affecting their self-image and relationship with others.
  • Coping strategies frequently used by men with a prostate cancer diagnosis was to resort to humor or avoidance or being in denial altogether of their disease or those who took the opportunity to talk about their diagnosis including offering support to other men also with this same diagnosis.
  • It was apparent that in order to improve communication between men and their providers, different approaches are necessary.

From this study, the commonality among the men was that support from healthcare professionals could improve by allowing more time to discuss treatment options and what other avenues of support in the community were available. Probably the most startling and disturbing finding was that the men described having prostate cancer as “an emasculating journey,” or one in which they felt less of a man or weaker in their role.

Overcoming stigma associated with prostate cancer

The reasonable approach to this issue of stigma surrounding prostate cancer is to look at the disease objectively. Considering the fact that prostate cancer is the second leading cause of cancer in American men after skin cancer and is the second leading cause of cancer death after lung cancer, it behooves men to pay attention to the health of their prostate. Each year about 190,000 men are diagnosed with prostate cancer and for the year 2020, it’s estimated more than 33,000 men will die of the disease.

Let’s take a look at some of the factors preventing men from possibly being proactive about prostate cancer and if given a diagnosis of it, how to still feel like a ‘man’ while asking for help for their disease.

It begins with testing for prostate cancer

Screenings for all kinds of cancer is one of the reasons more and more people are surviving this terrible disease. Early detection is key and this includes screenings for prostate cancer. The primary test for checking for prostate cancer is a simple blood test easily done in the doctor’s office called prostate specific antigen (PSA). This is no different than taking blood to check cholesterol or glucose levels. Most men likely are not opposed to a PSA test.  However, mention a digital rectal exam (DRE), and men clam up. While its understandable men are reluctant about undergoing this procedure, the DRE is quick and can provide valuable information to a man’s healthcare provider assessing his risk for prostate cancer. A discussion with their doctor can help alleviate any anxiety or feelings of shame men may be experiencing.

Treatment for prostate cancer

Every man will have their own unique experience with prostate cancer treatment. Men with this disease will have several options for treatment based on their specific staging and recommendations from their doctor. Whether undergoing surgery, radiation, active surveillance, or other treatments available, it is not unusual for men with prostate cancer to have both physical and emotional changes in their regular routine and overall life, temporarily. Few men like to show weakness when physically or mentally feeling unwell. But opening up being honest in sharing those feelings with close friends on how they feel, can be very cathartic in dealing with a situation that can feel worrisome and unsettling. It’s okay to ask for help, it’s okay to take time off, and it’s okay to admit your scared.

Dealing with side effects

Probably the biggest concerns most men have about prostate cancer are the inevitable side effects from the treatments. Since these side effects directly affect a man’s more intimate and private aspect of his life, talking about them can be embarrassing or feel shameful.

One side effect can be urinary issues of incontinence. Men are supposed to ‘tough it out’ but when you’re worried about dribbling in public, it’s a different story. Fortunately, this is generally temporary and by working with their healthcare team, can usually return to normal within a year or less.

The other side effect likely of most concern to men diagnosed with prostate cancer is related to their ability to perform sexually. Not every man will experience sexual side effects. But if they do, it may include erectile dysfunction, difficulty climaxing, less energy for sexual activity, or loss of interest in sex. It’s important for any man having sexual side effects from prostate cancer treatments to discuss this with his doctor. Generally, many of these issues will resolve in a few weeks or for some men longer. Discussing sexual side effects with their doctor right away can put men more in control of the situation as they get guidance for treatment options.

Keep lines of communication open

There is no reason any man should be stigmatized or shamed for a diagnosis of prostate cancer. There is also no reason any man should be reluctant to seek support and to talk about what he is experiencing. Of course, some men will find this cathartic while other men may not. But just like breast cancer, which was unmentionable 100 years ago and is now completely in the open, there is hope and progress being made in removing the stigma of prostate cancer.

That’s why communicating openly and honestly, whether with their partner or with other cancer survivors, is a far-reaching method for normalizing prostate cancer. And just like women who paved the way removing the stigma and shame of breast cancer decades ago, men who open up about a prostate cancer diagnosis, will discover most people genuinely will listen lending their support, comfort, and words of encouragement, with no stigma attached.

David Samadi, MD - Medical Contributor

View posts by David Samadi, MD - Medical Contributor
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter, Instagram, Pinterest, and Facebook.

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