Treatment sideeffects and their psychological impact

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Men confronted with this treatment decision often need to take into consideration a range of factors, including the potential physical side effects of treatments and their psychological, social and emotional consequences. For example, patients being treated with radical therapies can experience severe side-effects, such as urinary incontinence (UI) and erectile dysfunction (ED), as a result of treatment. UI symptoms can persist years after treatment [8] and this can have an impact on all aspects of an individual's functioning. Men with UI often avoid social situations due to the risk of their incontinence becoming apparent to other people. They can feel embarrassed by their inability to self-control their bodily functions and by the lack of empathy from other people within social situations [9].

Relatively little research has been conducted to examine the relationship between ED and psychological morbidity among men with prostate cancer. Nevertheless, ED has been reported to have a profound effect on a patient's quality of life post-treatment. Nelson et al. [10] examined the relationship between depressive symptoms and erectile function. A group of men, who did not receive any treatment for their prostate cancer, completed self-report questionnaires measuring anxiety and depression symptoms and erectile function approximately 4-years post-diagnosis. Erectile dysfunction was found to be a significant predictor of depression independent of other influential factors of depression, such as anxiety and marital status. This finding suggests that men can experience lasting psychological effects from their disease. Another study by Nelson et al. [11] examined men's responses to ED affecting their sexual function and their adjustment to diminished erections after having undergone a radical prostatectomy. These men completed self-report questionnaires measuring erectile function and sexual satisfaction pre-operatively, 12 and 24 months post-operatively. The findings revealed that sexual satisfaction decreased after surgery with patients feeling ashamed and embarrassed by their difficulty to perform sexually with their partners. Sexual dissatisfaction persisted over the period of 24-months, even in men who reported good erectile function post-operatively. Thus, it appears that men do not seem to adjust well to the consequences of their treatment.

ED is a condition which not only affects the individual but also affects couples. There have been differences in the perceptions held by men with ED due to treatment for prostate cancer and their partners. Men with ED have reported an "all or nothing" approach to their sexual relationship with their partner; in that if they are unable to 'perform' sexually then it is pointless to engage in sexual contact. This can lead to men withdrawing from intimate contact with their partners causing strain on the relationship [12]. Women partners have reported to be less concerned about treatments to help the physical functioning of their partners with ED, and are more focused on finding alternative ways to maintain intimacy and sexual stimulation [13].

The option of active surveillance as a management plan for LPCa can also affect the quality of life of men diagnosed with the disease. Although no active treatment is administered, active surveillance can have a psychological impact. Qualitative studies have provided some insight into the experiences of living with prostate cancer. For instance,

Hedestig et al. [14] conducted interviews with patient with untreated LPCa and analysed the interview transcripts using in-depth qualitative narrative analysis. Their findings revealed that men perceived their disease as life-threatening, experienced uncertainty, fear and worry about their cancer progression, and a repressed sense of manhood due to sexual dysfunctions.

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