It probably comes as no surprise, but it is worth remembering: Men diagnosed with prostate cancer have to cope with considerable amounts of stress. They even seem to be at an increased risk, when compared with men of the same age and with similar socioeconomic backgrounds, for anxiety, depression, post-traumatic stress disorder, and suicide. A new paper published in the European Journal of Cancer discusses this increased risk. (Read an abstract of this article.)

Pages in this section of “Life Beyond Cancer” will examine some of these psychological states, so men who experience symptoms can seek professional help and know that they are not alone.

Initial fears and decision-making anxiety
Of course, shock and worry occur when men first hear the words “You have prostate cancer.” A natural first reaction is to wonder whether your life is coming to an end: “Will I die from this?” And then comes the stress of accepting your diagnosis, telling friends and family, deciding among treatment options, and getting the best medical advice and therapy for your situation. Other stresses include making arrangements to take time off from your regular responsibilities, perhaps your job, and ensuring your financial stability during your time of treatment and recovery.

With all of these factors to cope with, men with prostate cancer frequently report short-term psychological distress, including, in rare circumstances, severe but transient anxiety, depression, and suicidal thoughts. Most often, however, worries begin to abate as decisions are made and treatment progresses. Men learn what to expect and how to cope, so their fear and anxiety lessen.

Worrying when treatment ends
Some men feel a return of anxiety once their treatment is over and they resume their “normal” lives. As stressful as the treatment period can be, you are actually doing something to fight your cancer during it. So you may experience a brief “funk” or “post-treatment blues” when therapy ends. You won’t be seeing your medical team as regularly, and withdrawal of the routine of treatment and immediate follow-up, which has seen you through the difficult days after your diagnosis, can leave you feeling a bit lost. You might also begin to worry anew about recurrence or metastases: “Without treatment, is my cancer growing again?”

Stress and the new “normal”
Sometimes, the side effects of treatment can have a serious emotional and psychological impact. Men may need professional counselling to cope with incontinence, erectile dysfunction, infertility, or bowel problems. The hormonal changes brought on by androgen-deprivation therapy may make men more susceptible to depression.

Even men who have no serious long-term treatment effects can have trouble adjusting to the “new normal.” Cancer causes people to confront their own mortality, to take a close look at their lives and relationships; this process can be both joyful and painful. It also makes people admit that, about many important things, they have little control. This realization can profoundly affect mood, especially if you have a take-charge personality.

Prostate cancer and the risk of depression or anxiety
Some men with prostate cancer find themselves unable to accept their condition. They remain worried or discouraged long after other men coping with the disease. In fact, research does indicate that men who have been diagnosed with prostate cancer are more likely to experience an anxiety disorder than men in the general community, and they are nearly twice as likely to develop depression. Other studies have found that partners of men with prostate cancer are at a greater risk for anxiety and depression as well.

Needless to say, anxiety is more than just feeling stressed, and depression is more than just a low mood. Both can be serious illnesses.

For more information:

Bertrand Tombal, 2010, Prostate cancer, depression, and risk of suicide: Should we pay more attention,  European Urology, volume 57, p. 396–397.

Network News article, October 2008, Male depression under-diagnosed: Why should men with prostate cancer care?