An anxiety disorder is much more than feeling stressed and anxious. Anxiety can be a serious and debilitating illness that makes it hard for people to function day to day. There are many types of anxiety disorders, including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder, and phobia. Research indicates that men with prostate cancer (and their partners) are at a greater risk of developing anxiety disorders than men in the general population. Generalized anxiety disorder and panic disorder, according to an Australian study, are the psychiatric diagnoses most common among prostate cancer patients and their partners. A more recent paper out of Sweden, however, suggests that rates of post-traumatic stress disorder are also higher for men diagnosed with prostate cancer.

What Is My Risk?
The National Cancer Institute (United States) lists several factors that can increase the likelihood of a cancer patient developing an anxiety disorder:

• a previous history of anxiety disorders,
• severe pain,
• experiencing anxiety at the time of diagnosis
• having other limitations that affect functioning (e.g., limited mobility),
• lack of social support,
• advancing disease, and
• a history of trauma (outside of the cancer diagnosis).

Not surprisingly, worries that are prostate-cancer specific can lead to an increased likelihood of a man experiencing an anxiety disorder. These worries may include the following:



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What Are the Symptoms?
There are numerous anxiety disorders, but the ones most commonly experienced by men with prostate cancer (and their partners) are described below. Each description is amplified by a list of symptoms. Remember, however, that only a medical professional can diagnose an anxiety disorder and that these lists are provided only as an information service—to help you in consultations with your doctors.

Generalized anxiety disorder (GAD)
This condition is described as an ongoing, unrealistic, and excessive anxiousness about two or more life circumstances or about life in general. Symptoms include

• feeling very worried for at least six months on more days than not;
• finding it difficult to stop worrying, even when you know your fears are not logical;
• having trouble doing everyday activities because of anxiety;
• experiencing motor tension, e.g., restlessness, muscle pain, and being easily fatigued;
• having difficulty concentrating, feeling irritable, feeling keyed up, and having exaggerated startle responses (all signs of vigilantly scanning your environment for danger);
• experiencing automatic hyperactivity, e.g., racing heart, shortness of breath, sweating, or dizziness; and
• having trouble getting to sleep or staying asleep.

Men diagnosed with GAD have described feeling afraid that no one will care for them, even when they know they have a good social support system and a loving family, or not being able to sleep because they are so worried about finances during the night, even when, in daylight, they recognize that their economic circumstances are excellent.

Panic disorder
Although more episodic than generalized anxiety disorder, panic disorder is very intense. It is characterized by panic “attacks” that happen suddenly and that, often, have no specific trigger. These attacks, which generally last for only a few minutes, can make men feel uncomfortable for hours, and fearing their onset may lead men to experience uneasiness over even longer periods of time. Symptoms include

• feeling shaky, dizzy, light headed, or faint;
• shortness of breath;
• experiencing an increased heart rate and palpitations;
• sweating (diaphoresis);
• feeling choked;
• being nauseous or having stomach pain;
• feeling numb or tingly;
• having hot or cold flashes;
• feeling detached from your body or your surroundings; and
• being afraid that you are going crazy, having a heart attack, or dying.

Post-traumatic stress disorder (PTSD)
Although less common, this condition is also more prevalent among men diagnosed with prostate cancer than it is in the general population. Perhaps this added risk is simply a consequence of all of these men having “experienced something that involves death,” one of PTSD’s precursors. An article in the American Journal of Men’s Health concludes that PTSD symptoms were much more common among patients undergoing radical prostatectomy than they were among those who underwent surgery for benign prostatic hyperplasia (BPH), for example.

Some of the main symptoms of PTSD are

• re-experiencing a traumatic event (having nightmares or upsetting memories about, for example, your prostate cancer being diagnosed or growing);
• avoiding anything associated with that event and having trouble remembering parts of it (e.g., delaying PSA testing or forgetting about recommended treatments or visits to your doctor);
• feeling numb emotionally (e.g., finding it hard to experience intensely positive emotions such as love or enthusiasm, thinking less about the future, or having trouble remaining connected to or concerned about your daily life); and
• being excessively vigilant or aroused to the possibility of danger (e.g., feeling irritable or angry, unable to sleep or to concentrate, or being always on guard or easily startled).

Diagnosis and Treatment
It is very important for anyone experiencing these symptoms to seek professional medical help. An accurate diagnosis is essential, not only of the disorder but also of whether this disorder is situational (i.e., caused by circumstances such as pain, an underlying physical problem, a new medication, or a change in hormone levels). There is even an anxiety disorder diagnosis tool that is prostate-cancer specific: The Memorial Anxiety Scale of Prostate Cancer. (See an article in Cancer about this scale.)

Remember, the earlier you seek professional help, the faster you are likely to recover. If the disorder has been triggered by a particular medication or by an imbalance that is the side effect of therapy, prompt treatment of the cause can lead to very quick control of the symptoms.

For less responsive disorders, treatments usually fall into one of three categories: psychological interventions, medicines, and lifestyle changes. Of course, a complete treatment program often contains elements from all three categories.

Psychological interventions
Psychological approaches to treating anxiety have often been called “talk” therapy, although they do often involve more than counselling. Some of these therapies include

• Cognitive behaviour therapy, a structured and goal-oriented program that teaches people to recognize their unhelpful and irrational thoughts and anxieties and to develop strategies to face and cope with their fears gradually;
• Interpersonal therapy, which helps people strengthen their important personal relationships so as to resolve changes and conflict and to find the support they need in their anxious times;
• Family therapy, which assists families and friends to learn about anxiety disorders and to help the person suffering from anxiety identify stressors, cope with stress, and monitor progress; and
• Relaxation approaches such as hypnosis, meditation, progressive relaxation, guided imagery, and biofeedback, which are used to treat the symptoms of anxiety (e.g., the fight or flight response to stress).

Medicines
Various drugs are used on a short-term or long-term basis to treat anxiety. Whether medications are used depends on a number of factors, including the severity of anxiety symptoms, how much they affect functioning, a person’s mental health history, and a man’s prostate cancer prognosis and treatment regime.

Sometimes, low-dose antidepressants, such as selective serotonin-reuptake inhibitors (SSRIs), are prescribed for both anxiety and depression. In the treatment of acute anxiety, psychiatrists may also prescribe mild tranquilizers, such as benzodiazepines. It is very important that both your mental health practitioner and the team heading up your prostate cancer treatment review all of your medications, including over-the-counter remedies.

Lifestyle changes
People suffering from anxiety disorders should get professional help. But there are some things that you can do to complement your therapy.

• Get support. Find friends or family members with whom you can talk. Consider joining a support group. Knowing that you are not alone, that others have specific fears about prostate cancer and how it affects life and relationships, and that some have even battled anxiety disorders can be a powerful help.
• Write down your worries and evaluate them. You might find that some concerns are reasonable, that you can take practical steps to address them. Other anxieties may irrational or unhelpful.
• Exercise. When you are anxious, a daily walk or some other form of cardiovascular activity can boost your mood. If you can combine exercise with a pleasant “time out” amongst friends, for example, a friendly golf game, even better.
• Follow a healthy diet. Avoid caffeine, junk foods, alcohol, and tobacco.
• Try to establish good sleeping patterns. Get out of bed as soon as you are awake in the morning (and at about the same time each day), don’t nap or try to make up for lost sleep during the day, establish a before-bed routine that includes giving yourself time to wind down and to empty your bladder. Also keeping your bedroom quiet and comfortable, and only using it for sex or sleeping can help.
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For more information:

beyondblue: the national depression initiative, 2010, Maintaining your well-being: Information on depression and anxiety for men with prostate cancer and their partners, produced with the Prostate Cancer Foundation of Australia and supported by Movember.

National Cancer Institute, 2011, Adjustment to cancer: Anxiety and distress PDQ.