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Men with prostate cancer often experience erectile dysfunction as a side effect of their treatment, and many find this to be upsetting to the point where it undermines their wellbeing. Moreover, men's distress about ED often does not improve over time — in some men, it worsens.
A new study sheds light on the causes of this prolonged distress. While some researchers have thought that the severity of a man's ED is linked with how distressed he feels, the new findings show that regardless of men's ED severity, they are much more likely to be distressed when they feel they've lost their masculinity as a result of treatment.
Not all men experience this feeling of lost masculinity, said study researcher Talia Zaider, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York City. But those who do are most at risk of feeling deeply troubled, embarrassed or ashamed about their ED.
A feeling of lost masculinity is an aspect of prostate cancer treatment that's not often talked about, Zaider said. "Gender norms work against men," and can keep them from discussing it, she said.
In the study, about one-third of men who had been treated for prostate cancer in the last year reported feeling their masculinity was diminished, and that they had lost a vital part of their identity, Zaider said.
A better understanding of how men respond to their sense of a change in their identity could help researchers find better ways to help men recover, the researchers wrote in their study, published online Sept. 18 in the Journal of Sexual Medicine.
About 242,000 men in the U.S. will be diagnosed with prostate cancer in 2012, and 28,000 will die of the disease this year, according to estimates from the National Cancer Institute. More than 9 in 10 prostate cancers are diagnosed in early stages, and these men are likely to live for a long time after treatment.
This optimistic outlook on survival means that researchers are looking closely at factors affecting men's quality of life after the treatment, Zaider said.
Treatments can affect men's sexual, urinary and bowel functioning, but i mpaired sexual functioning is the most common long-term complaint of men after treatment, according to the study.
Zaider and colleagues interviewed 75 men, whose average age was 60, who had received prostate cancer treatment in the previous year.
The men answered questions about their level of erectile function, how happy they were with their sex lives, the degree to which they felt a loss of masculinity, and the amount of "marital affection" they felt in their relationship (all men in the study were living with a spouse or partner). The men's spouses were also interviewed.
"Men who felt they'd lost their masculine identity were very likely to be stressed by their ED. The two seemed to go closely together," Zaider said. "That link was there whether they had severe or mild ED."
The researchers also found that among men who felt a lost of their masculinity, those in relationships with a high degree of affection were less likely to feel distress over their ED.
But women don't always understand their husbands' feelings. "I've worked with couples, and when the man talks about how upset he is about his loss of erectile function, the wife says, 'but you're alive, and we're OK,'" Zaider said. "For men, it's not just about their function — it signifies a loss of who they are. There are feelings of incompleteness."
The findings make a case for involving men's partners in interventions aimed at helping men cope with their distress, she said. The researchers have begun a trial to test the effectiveness of such an intervention.
"Perhaps in the context of a strong, affectionate and communicative relationship, men can revise their ideas about what makes them a man and, in turn, adjust better to ED," Zaider said.
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"Perhaps in the context of a strong, affectionate and communicative relationship, men can revise their ideas about what makes them a man and, in turn, adjust better to ED,"
That's it in a nutshell. We've got to revise our ideas about sex as well. It is no substitute for love.
ZINC....take a pill every day and you will die happy...WITH your prostate....no doctor will tell you about this non-certified report about zinc but they ALL have read it and they all take zinc.
The article is BS from start to finish:
1) All the PSA tests, bioipsies, and treatments (including surgery, chemo and radiation) in the world do NOT improve overall survivability either from all causes or from prostate cancer. Period. There is no evidence in existence to support the massive amounts of money spent on prostate cancer.
2) 19 out of every 20 cases of prostate cancer donot require treatment. They are of a slow-growing type that does not kill people. Gerontologists (including my wife) see prostate cancer as a "condition of aging" not a "disease function." The fast-growing type of prostate cancer cannot be detected or diagnosed by PSA's or by biopsies. So urologists contend that they must unnecessarily treat 19 men to catch just one case of fast-growing prostate cancer. But even the fast-growing type does not benefit in survivability from intervention.
3) Urologists routinely lie about the effects of prostate cancer treatment, telling men that they will see the side effects --- incontinence, erectile disfunction, and loss of bowel control --- improve over time. There is no evidence that there is any improvement as far out as ten years. Urologists believe that it is justified to lie to patients because if they knew the truth about side effects, fewer would have the "treatments" that are a major revenue stream for urologists and oncologists.
4) There is a mounting body of evidence that a major cause of fast-growing prostate cancer are biopsies themselves. Careful analysis of cancerous prostates removed in surgery are showing slow-growing cancer cells throughout the prostate and the fast-growing cells only along the needle tracks. This is called needle trace tracking or needle tracking if you want to look at the literature yourselves.
5) There are an increasing number of lawsuits against urologists for performing contra-indicated and useless surgery based on lies. There are lawsuits involving the lies about side effects. And the "holy grail" of many urologists is exactly what this "study" purports to find --- that the victims are to be blamed for their side effects. This information was not intended to assist victims of prostate cancer, but to assist lawyers defending urologists.
6) If you look at Tahlia Zaider's c.v., you will find that she is a clinicial with no research training or skills. This sor of "research" is far beyond her training and capacity. She is a family therapist who apparently claims, at times, to be an MD (she is NOT.) Allk this person is doing is setting herself up to testify for urologists in cases where the victims of those urologists are suing because they were told lies to get them to take unnecessary, invasive, and harmful "therapies" and tests for which there is absolutely no evidence that the tests and therapies increase lifespan either from all causes or from prostate cancer only, and lies about the prevalence and seriousness of the side effects.
I am working with this because a year ago I has a 12 PSA and a supposed high velicity. Luckily my wife is a research gerontologist and with the help of a couple of grad student volunteers I was able to do a complete lit search on prostate cancer that was vetted by my wife --- who does nhave the research skills. My findings exactly matched the findings which came out a couple of months later by the US Preventive Services Task Force on Screening For Prostate Cancer. Here is a link to that report if you want to check it out for yourself:
http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm
If you find yourself in the same situation, feel free to e-mail (via NewsVinbe) for more research resources and real journal articles from real researchers with the skillset and objectivity to conduct medical research.
Chris, Thanks for the great information. Prostate surgery has ramped up in the last few years. Seems almost every man I talk to has either had it, or knows someone who does. Not one of them was happy about the side effects, which they say many doctors gloss over. Yes, if you have an agressive cancer, surgery might be warranted, but a high PSA count is often all it takes, and the next thing you know, you are having a radical "gold standard" surgery. There are a lot of psychological aspects to being diagnosed with cancer and when you add impotence, incontience, gential shrinkage and bowel malfunctions, it can be very depressing. Again, thanks for the information.
Good job Chris! I have a brother who went for all the medical work; he's dieing and has a miserable life. I recently got a report of an elevated PSA. I'm in my mid-late 60's, my beautiful wife and I have a wonderful sex life. I'd, seriously, rather die than lose that. My doc looked shocked, like long life was everything.
hate to tell you chris but i was diagnosed with a very aggressive prostate cancer about 2 years ago, thank God that I HAD the biopsy that DID discover it, just before it got to the point of "no return". In other words...PAY ATTENTION TO THE PSA NUMBERS AND DEFINATELY HAVE THE BIOPSY DONE.
It's true that most prostate cancers are slow growing and that the man will likely die from other causes before it's a problem, but some men do have aggressive cancer that needs treatment. Furthermore, Zaider does BEHAVIORAL research, which is what she comments on. She studies the emotional after effects of treatment- not whether men should have treatments. One doesn't need an MD to do legitimate behavioral research. Her research points out a sad truth: men's lives revolve around sex and sex, not love, is required for their sense of well-being. It's a shame for their wives, who couldn't care less whether their husbands are "fully functional".
Dear Chris hope yhou live well and prosper. So why hasn't this information become more forthcoming.
My issue as a breast cancer suvivor and a woman with a potential side effect from Tamoxifen- causing a radical TAH- your wife can tell about that!- And a husband who had prostate surgery 6 years prior.
Well , Sir, if sex is the center of your life- you obviously never had children or grnadchildren or a family to love and revel in. My comment to you- it isn't the SEX as our society makes it so important- it is the relationship of people. WE ARE EACH OTHER'S BEST FRIENDS! and if that doesn't count then what does. I suspect you do not have a friend with your researcher, but someone who love to expound on "knowledge" that still isn't published.
What is it?
Sorry you do not have a best friend they are really teh greatest!
I totally agree with Chris. Docs don't tell you that you'll never ejaculate again, and getting it up is difficult. While there are certainly men who die of prostate cancer, I think overall this is a legal and medical scam. The insurance companies use a PSA of over 9 to deny life and medical insurance and the docs and hospitals charge 10s of thousands for a procedure with zero evidence through double blind studies that it works. What a bunch of crap. I wish to high heaven I had not had any treatment and I tell every man I know who goes for a PSA to forget about it. The urologist was useless, he provided zero info and I was on my own. He handed some bull@!$%# flyer put out by a "scare the hell out of" organization that didn't even MENTION the no treatment option.....All in all, this is just a money maker for the medical profession with little, if any, benefit to men.
Definitely have the PSA test done regularly after age 50 and get the biopsy done if you have three elevated PSAs or more in a row. I did have the elevated PSAs in my mid 50's, and thank god I had the biopsy done which showed considerable cancer, but still localized. I had radiation and am still cancer free today, some 10 years later. Had I ignored the test results, I was young enough that the cancer would have progressed to an untreatable and disabling stage while I otherwise still had a lot of life to go.
And by the way, men value erections far too much. If you lose it, it ain't the end of the world. Volunteer at your local senior center and you'll forget all your troubles in a hurry.
Anybody that values good sex over life itself needs to have their head examined. Literally.
It's not that they enjoy sex over life, it's that sex is great, especially when shared with a loved one who also enjoys and looks forward to it. Yes, it's not the end of the world, but certainly is a big loss for some people.
As a woman who has experienced the after-effects of chemo and radiation which also affected my pelvic region, I can probably relate to this more than others can. Any treatment in that area - whether for ovarian, cervical, uterine or other "female"-reproductive-system cancers - also has similar, not-too-nice-to-cope-with side effects. Men tie their sense of self-worth to things that maybe DON'T seem like that big of a deal to women. Sex and the ability to make love is one of those things, and being gainfully employed is another.
I agree with jkatze - sex is no substitute for love. BUT an understanding partner can make a big difference. I would like a study like this for WOMEN affected by reproductive-organ cancers. October is PINKtober, and those of us who do NOT have this kind of cancer, get swept under the rug. Men as well as women. Maybe in the future, PINKtober could become an ALL-cancer-awareness month. It's overdue.
It's hard not being able to get hard.
Chris, While I agree with you on #3, I find you are generalizing as much as the author. My husband had aggressive prostate cancer at age 50. His surgeon did downplay the sexual effects, but if he had not had surgery, he would be dead by now (we're in our early 60s). I made sure he understood that avoiding sex was out of the question. There are other ways to have an orgasm and they can be lots of fun. We're still having fun! Fortunately, I hear men talking to one another about this more often now. I've even talked to male friends and co-workers who were facing the prostate cancer decision. Prostate cancer should not be a secret! And I do understand the "live with it and die from something else" aspect. My father was in his 90s before he passed on. And Jessica, I agree with you. The whole breast cancer movement has become so strong that we lose the other types in the process. Yes, I know these types need their own champions or leaders, but I'm not sure when or if that will happen. I think when the boys wear pink at their football or basketball games that they really need to wear blue and they should learn about prostate cancer. I don't think the folks at Susan G. Komen are going to make that move, however.
Um, that's what Viagra and Cialis is for duh.
They don't work for all men--especially if there was significant nerve damage in surgery. Just as you shouldn't take a surgeon's word on side effects, you also shouldn't put your faith in television commercials--duh!
Troy.....Drugs only treat the physical part....the mental part is what is damaged...duh
What isn't said at all in this report is that when a prostatectomy is done most all of the men get ED, since they've just had most all their nerves to their "sex organ" cut out! If they have radiation instead, after 3-4 years 30-40% of men develop ED due to the effect of the radiation on the nerves to the sex organ. Hello? What's all this bs about the "psychological effect" when there is VERY strong physical evidence it is due to the surgery and radiation.
Not with state-of-the-art robotic prostatectomy techniques. The nerves are spared almost 100%.
Not if you have perineural invasion they aren't. Anyone who goes into radical prostatectomy, and thinks it will be a walk in the park because they're using a robot, is seriously deluded or being lied to by their surgeon. They have recently done studies that do not support that claim, and most of the evidence used by these surgeons is anecdotal, which means they don't consider the bad outcomes.
I find noteworthy the following remarks in the article:
"The researchers also found that among men who felt a loss of their masculinity, those in relationships with a high degree of affection were less likely to feel distress over their ED.
But women don't always understand their husbands' feelings. "I've worked with couples, and when the man talks about how upset he is about his loss of erectile function, the wife says, 'but you're alive, and we're OK,'" Zaider said. "For men, it's not just about their function — it signifies a loss of who they are. There are feelings of incompleteness."
"The findings make a case for involving men's partners in interventions aimed at helping men cope with their distress, she said. The researchers have begun a trial to test the effectiveness of such an intervention.
"Perhaps in the context of a strong, affectionate and communicative relationship, men can revise their ideas about what makes them a man and, in turn, adjust better to ED," Zaider said."
Too often men diagnosed with prostate cancer fail to include their spouse/partner in the activities involved in their diagnosis, treatment, and side effects experienced. I have heard from too many spouses that rather than be open and communicative of what they are experiencing, men rather somewhat shun their spouses/partners preferring to keep what they are experiencing to themselves; too often claiming it is "theirs" to deal with.
As a result, the spouse/partner is left with a feeling of separation from closeness and affection and emotional loss of what to do.
Take note that couples "in relationships with a high degree of affection" and "strong, affectionate and communicative relationships" were less likely to feel distress over their erectile dysfunction.
My personal opinion regarding supposed "loss of masculinity" is explained
here:
If your spouse has a high sex drive, you can snuggle and show her all you want, but in the end she may leave you for a man that functions.
I was 43 when I was diagnosed with PC, PSA was 8.0 and path report was Gleason 6. Four months later after exhaustive research. I decided to have my prostate removed by an experienced surgeon, 1000 surgeries. Ostpolitikost surgical Gleason remained 6, my nerves were sparred, but I had one positive surgical margin. In March it will be 2 years, man time flies, all my PSA results remain undetectable to date.
For a guy at my age and pretty much getting it "ON" when the wife was willing of course, I was SCARED sh@$less about losing that ability! Well for me, while taking Viagra, the first 7 months were just plain AWEFUL! Totally impotent! But, my wife was very understanding and we still managed to have fun, especially her. Yet, for the first time in my life I was depressed! My doctor assured me that it would take time and that since I was potenent when I came to him I would return "close" to my old self. I continued doing the exercises they recommended...pump & kegals.
After about 71/2 loong months I was finally able to have REAL sex! I was so excited we decided to go for seconds! Of course, I had taken one 100mg Viagra, but hey who cares! Today, I cut a pill into 1/4's and take one every now and then, but believe it or not I usually take nothing! My surgeon says that out of all his patients I am by far the youngest and am far ahead of everyone in the sex department. He was shocked that I didn't use any ED drugs most time and how quickly I had recovered! I do recall him saying a couple weeks after my surgery that he was "impressed" with my nerve bundles, aside from my age maybe this also contributed to my speedy sexual recovery.
Am I the norm? Not by any stretch of the imagination, but for me because of my age surgery had to be the best option. Although, I was a Gleason 6 with the "garden variety" PC it seemed crazy to take the wait and see approach because of its slow growth since most people in my family live into their 80's and some 90's. It grows slow, but not that slow!
Since men my age rarely get PC there are no studies that I am aware of to guide guys younger than 50. With all this talk against PSA testing and all this talk against prostatectomies given my circumstances what were my options? What would you have done? Lastly, I do not have any incontinence either! Aside from the totally weirdness of not ejaculating semen, sex at times is better than before. The O's are pretty intense for both of us!!!
This discussion brings back memories of many things in my life. Any one who takes a doctors word that surgery is necessary is gambling with his life. You need to have more than one opinion and then do your homework. My husband died three years ago and could very well be alive today, if not for lying doctors. He had a little trouble breathing one evening and went to emergency. The doctors did an angiogram and said all his arteries were blocked and he needed a cardiac bypass asap. Has anyone ever known of a "good" result after an angiogram? I tried to persuade him to have Chelation therapy and had him convinced, but after I left the hospital a team of doctors descended on him and told him that if he left the hospital, he would only get to the front door and drop dead. He had what was supposed to be a quadruple bypass, but when the surgeon came to speak to me, he said that he had only done a double. I then asked why he had said that there were two 100% and two 90% blockages. He told me that the 100% blockages had probably bypassed themselves. My husband had an angiogram, which determines efficiency of the heart's pumping ability. Before surgery it was 30% and after, it was 17%. It gradually got to 10% and he died a miserable death, with no decent quality of life for some time. At the age of 32 I was told that I needed to have a hysterectomy because I had fibroids in my uterus and they would likely turn cancerous. I had it done, only to learn later that this was totally untrue. As for prostate cancer, My brother has prostate cancer and after going to visit a support group, before doing anything, he decided on holistic treatment and is doing well since '04. At the group there were several men in diapers, whose doctors had said incontinence would be temporary. One fellow said "Its been over three years, I don't think this is the definition of temporary." It certainly would help if everyone spent some time researching what mainstream doctors are doing to all of us. In Mexico and Germany, many people are being cured of cancer who are terminal. With all the huge sums of money given for research, it's obvious that doctors, the FDA and Big Pharma don't want the cash cow that is cancer to go away.Same for heart disease, diabetes etc. So much for the oath that graduating doctors swear, "First do no harm."
I made a mistake in the previous post. The second test that I mentioned for heart efficiency is an echocardiogram.