Biopsychosocial Aspects of Prostate Cancer -- Kunkel et al. 41 (2): 85 -- Psychosomatics

[Guest guest]

This

article is 8 years old but it doesn’t seem as if things have changed

that much.

http://psy.psychiatryonline.org/cgi/content/full/41/2/85

Although

African American men are twice as likely as white men to get

prostate cancer, African American men in Philadelphia

do not perceive their personal risk of prostate cancer to be high.3

Only some studies reveal differences in the frequency of digital

rectal exam (DRE) screening between African American men and white

men.4

African American men are more likely to be diagnosed at later

stages, and men 65–69 years old, with localized disease, are

less likely to be treated via radical prostatectomy (RP).5

In one

study, non–private patients were less likely to receive

prostate-specific antigen (PSA) screening.4

Lower socioeconomic groups are less willing than middle socioeconomic

groups to participate in clinical trials because of distrust of the

medical community.6,7

RP is used more commonly in younger men (<60 years), and

radiotherapy (RT) or watchful waiting is mostly used in older men

(>70 years). Married men tend to be diagnosed earlier. Not

surprisingly, survival rates are higher in married men from higher

socioeconomic strata.8

Perceived

discomfort of prostate screening, embarrassment, and financial cost

have been identified as barriers to screening and need to be

addressed by sensitive counselors.9

Churches consisting of predominantly African American members, and

work sites may be effective sites for prostate cancer screening and

education.10

Patients, particularly poorer

African Americans, may opt to forgo needed care in the absence of

available and affordable means of transportation to treatment

facilities. Healthcare providers need to work with patients,

families, and volunteer agencies in the community to enhance

transportation to cancer treatment.11

Although racially and culturally sensitive educational outreach

programs need to provide education about prostate cancer and reduce

barriers to early detection of prostate cancer among African

American men, the relationship between access to care and prostate

cancer outcome remains unclear.12

Snip

Men

undergoing early detection for prostate cancer experience uncertainty

related to the time course of cancer and often fear treatment and

treatment-related side effects. It is still unclear whether early

detection can reduce disease-specific mortality, and therein lies

the controversy about early detection. Healthcare providers need to

consider patient and family beliefs in the context of ethnocentric

values. Although most patients are able to adapt to the cancer

diagnosis and its management, QOL and treatment complications should

be discussed by physicians who can counsel patients in the selection

of preferred courses of treatments. Treatment choices are made more

difficult by the lack of information on the long-term relative

effectiveness of RP vs. RT.

Ideally,

the management of anxiety and depression requires a multidisciplinary

and multimodal approach. Psychiatrists can assist as diagnostic

consultants in monitoring adjuvant psychotropic medications and in

providing appropriate psychotherapy for treatment for men with

prostate cancer and their families. An understanding of the current

controversies in early detection and treatment can assist the C-L

psychiatrist in working through difficult medical decisions with

their patients.