Prostate cancer is usually a slow-growing cancer and, if caught at an early stage, can be cured. With all the advanced technologies that today allow for early detection and successful new treatments now available for prostate cancer, the disease can often be controlled for years and can even be cured.
The exact causes of prostate cancer are still unknown. Some research seems to indicate that certain factors may put men at a higher risk for developing it: being over the age of fifty (the risk increases with aging), having fathers or brothers who have had prostate cancer, being of African-Canadian ancestry, and habitually consuming a diet high in animal fat.
The diagnosis of prostate cancer is a stressful event which often creates feelings of helplessness, hopelessness and uncertainty about the future. It can provoke important psychological and emotional reactions – worries, fears, isolation and a feeling of loss of control over one’s life.
One may experience some of these feelings even before the actual diagnosis. Elevated PSA reading, scheduled biopsies, the waiting until a possible eventual diagnosis of prostate cancer are all events that can be psychologically devastating.
Since childhood, we have seen or known people who have died of cancer – a dreadful disease that is too often perceived as one accompanied by pain, suffering and death. We often think, and always hope, that cancer will not hit home, but unfortunately sometimes it does. And when it does, it not only affects the patient but also his whole family.
When a man learns that he has prostate cancer, he may be too numb to actually register anything else than the word “cancer.” He may then start questioning himself. “Why me” “What did I do wrong for this to happen to me” “This is not fair!” As a consequence of this guilt, anger may result. All the unknowns about the disease, the treatments, the temporary changes of roles at home and what the future will bring can be very frightening.
In reality, being diagnosed with prostate cancer is no one’s fault. Thinking that one is alone, not knowing who to turn to, what the resources are, and not wanting to burden anyone can make one feel really isolated. In reality, you are not alone. It is estimated that this year, 26,500 Canadians will be diagnosed with prostate cancer. One in every seven men will be diagnosed with prostate cancer at some point in their lives.
Educating yourself is a good starting point. It may help decrease some of the anxieties created by this new diagnosis and help you regain some control over your life. It may also facilitate any decisions that need to be made regarding this new crisis. There are medical and support resources available to help you move forward. We encourage you to read through this web site and become an informed partner with your healthcare professionals concerning your treatment plan.
Sharing the news
Informing family and friends
No one should attempt to go through a major crisis like cancer alone. Support is available all around you. After the initial shock, one may wonder: Who do I tell? How much should I tell? When should I tell them? And how will people react? A wide range of emotions are created in the wake of the initial shock of the diagnosis. You may undergo a variety of mood swings, ranging through denial, fear, depression and anger, and can temporarily seem to alter your personality. To those people close to you and who know you well, these changes may become noticeable and may indicate that something is wrong. People will learn about your diagnosis sooner or later; in many cases, it is better that they hear it from you.
You will eventually find the inner strength and the right timing to share the news. You will make the choice as to who you tell within your family and/or your closest friends. Most people agree that even children should know, even though the instinct may be to shield them from this fact. They too can perceive when something is wrong. How much you tell others will depend on the age and emotional maturity of the individual, and on your own comfort level.
People will react differently to the news. Don’t be upset if they don’t respond right away. They may require different amounts of time to adjust but, by talking about it, you allow communication to take place. This gives everyone an opportunity to share feelings, provide reassurance and to support each other. In time, most people will find their own way of adequately dealing with this new stressful event.
Coping with your feelings
Reactions such as shock, disbelief, anger, fear and denial are all normal responses to a life-threatening disease. They can impede your quality of life and must be addressed so that you can move forward. The more you try to ignore these fears, the more they will grow and consume energy that should be used to fight your cancer.
We know that everyone is unique and has different ways of coping with stressful situations. Coming to terms with the reality of prostate cancer is an important first step in planning how to face the new challenges brought on by your situation. Here is a list of coping strategies to help you deal with your prostate cancer:
Express your emotions.
- Reach out for support: family members, close friends and/or support resources are there to help.
- Educate yourself on prostate cancer, its treatments and side effects: this will help you take an active part in the decision-making process about your illness.
- Don’t be afraid to ask your doctor questions.
- Maintain your self-esteem by living one day at a time, sustaining a positive attitude and finding optimistic meanings and realistic goals that will fulfill your life.
- Keep in touch with your spiritual beliefs and come to terms with your mortality.
Understanding your choices
Deciding on your treatment choices
People recently diagnosed with prostate cancer experience heightened levels of stress and anxiety, which can interfere with the ability to process information. This makes it very difficult to make informed decisions, especially when they are some of the most important ones you can make in life. That is why the relationship between doctor and patient becomes crucial – it should be based on open communication and trust. Your doctor should see you as a human being with psychological, psychosocial, emotional and cultural needs in addition to medical treatments. You must work as a team to treat the cancer most effectively.
Here are a few points to make your visit at your doctor as efficient as possible:
- Don’t be afraid to ask questions about your disease, its treatments and side effects.
- Keep a running list of your questions as they come to mind.
- Take a relative or a friend with you.
- If your doctor is giving you too much information at one time, let him or her know. There is nothing wrong with indicating how much you can absorb at one visit.
Here are some questions you may want to ask your urologist, radiation oncologist or medical oncologist. They are classified into different sections to meet your needs:
Questions you should ask
- When is prostate cancer curable?
- Is the cancer confined to the prostate?
- What are the treatment options available for me?
- Which one will give me the best chance of survival without interfering too much with my quality of life? (Specify to your specialist what you mean by quality of life, for example: is preserving your erectile function or your bladder control important to you?)
Observation (Watchful Waiting)
- Is watchful waiting an alternative for me? Why? Why not?
- Is a radical prostatectomy an alternative for me? Why? Why not? What are its side effects?
- If a radical prostatectomy is indicated to treat my cancer, should it be done by a retropubic approach or by laparoscopy? Why?
- What is the likelihood that I will lose control of my bladder if I undergo a radical prostatectomy? Are there any exercises or therapy I can do to prevent this side effect?
- What is the likelihood that I will experience problems obtaining or maintaining an erection if I undergo a radical prostatectomy?
Radiation Therapy / Brachytherapy
- Is radiation therapy an alternative for me? Why? Why not? What are its side effects?
- Could brachytherapy be an option to treat my cancer? Why? Why not? What are its side effects?
- Is hormonal therapy an alternative for me? Why? Why not? What can I expect as side effects?
- Is prostate cancer chemotherapy very toxic?
- How effective is chemotherapy to treat prostate cancer?
- If the prostate cancer is not responding anymore to the available treatment options, what is next in store for me?
It is important for you to have enough information to understand what is going on. This will help you feel more in control of your life and will make decision-making easier. If you don’t feel at ease with your doctor for any reason, you should ask for a second opinion. By doing so you are not questioning his or her competency. Certain elements in the doctor-patient relationship might influence you to consider taking this action. Ask yourself the following questions:
- Does my doctor spend enough time with me?
- Are my questions being answered?
- Is the language my doctor uses clear, or is it too medical or technical?
- Is there a language barrier?
- Does my doctor practice too far away from my home?
Perhaps you and your family members simply need more reassurance about the possible treatment options and what would be the best approach to treat your cancer. Seeking a second opinion is a perfectly acceptable action to take if you feel the need. Just let your urologist know – he or she may even suggest someone or give you information on how to get a copy of your chart.
Who can help
As soon as you are diagnosed with prostate cancer, you and your family will be involved in a long process both inside and outside the hospital. You will meet several healthcare professionals, which at times may seem confusing. Here is the list of the different members of the medical team with whom you could be in contact.
A family physician – also known as a general practitioner – is dedicated to the prevention and treatment of illnesses and injuries and plays an important part in a person’s general healthcare before, during and after cancer treatments. He will consider your overall health and refer you, if necessary, to the right specialist.
A urologist is a doctor specializing in the diagnosis and treatment of diseases that affect the genital-urinary tract system of men and women. This specialist treats the following disorders and diseases:
- Prostate problems such as benign prostatic hyperplasia (BPH), prostatitis (infection) and cancer
- Obstruction of the urinary tract
- Urinary tract infections
- Testicular cancer
- Bladder disorders, such as incontinence, overactive bladder, interstitial cystitis, stones, neurogenic bladder and cancer
- Kidney disorders, including lithiasis and cancer
- Penile problems, including erectile dysfunction, Peyronie’s disease and cancer
- Reproductive health system and infertility
- Trauma inflicted on genital organs
- Urological problems specific to children
For any problem mentioned above, do not hesitate to consult your family doctor who will refer you to a urologist.
The radiation oncologist specializes in the treatment of cancer by radiation therapy. Depending on the type of tumor, its site and its spread, the radiation oncologist will decide on the best radiation procedure, dosage and the number of treatments required. If your urologist feels that radiation therapy is the best method to treat your cancer, he will refer you to this specialist.
A radiation therapist helps plan and deliver your treatment and manage side effects.
Radiologists are doctors who read and interpret x-rays, ultrasounds, CT scans, MRIs and other scans to diagnose diseases. A radiologist performs biopsies guided by x-rays or ultrasound.
The oncologist is a physician specializing in chemotherapy treatments, which involve the use of drugs to treat cancer. This professional has extensive experience in the alleviation of physical symptoms, such as pain, as well as in the relief of emotional, psychological and moral problems. If hormone therapy has no effect on cancer, you may be referred to an oncologist for chemotherapy. In some clinical trials, chemotherapy may be used in combination with other types of treatments.
Specialist in palliative care
The expertise of the palliative care physician is entirely focused on treatments to relieve the symptoms of a disease, which are similar to the symptoms of end-stage cancer. The goal of treatment is to reduce the symptoms associated with the disease, including pain, and to optimize the patient’s functional capacity and quality of life.
Nurses are specially trained to meet the medical needs of patients on a daily basis and provide them with the necessary support. For example, a nurse assigned to care for patients with prostate cancer as well as helping their family, should:
- provide information about the disease, its treatments and side effects, and answer some questions about it;
- help patients adjust to the side effects of treatments and refer them to a specialist;
- administer medications as prescribed by the physician and monitor side effects;
- listen to the emotional, psychological and physical needs of patients and refer accordingly (eg, to a CLSC or social worker).
The psychiatrist is a medical specialist who can diagnose psychosocial problems, evaluate underlying physical disorders and prescribe medication. The psychiatrist can also treat patients for pain. A psychiatrist can help the patient physically as well as psychologically.
The psychologist can help in coping with emotional or psychological reactions to the disease and its treatment. He or she can also help in understanding the reactions of family members. The goal of consulting a psychologist is to improve quality of life, psychological health and the patient’s and the family’s coping capabilities.
A sex therapist can help the patient and the couple overcome physical problems or learn how to live with them. For example, the sex therapist provides guidance if the man is unable to achieve erections naturally and the couple is learning how to integrate a medical treatment (oral medication, MUSE or any other type of treatment) into their sex life. The therapist also helps the couple explore other facets of their sexuality and new ways of expressing their love for each other. Sexuality can take a number of forms and still be fulfilling for both partners, as long as it remains a way for the couple to communicate and express their shared happiness. If the man is undergoing hormone therapy and has therefore lost his sex drive, the sex therapist helps the patient and the couple deal with the situation to prevent suffering, depression and guilt.
Pharmacists prepare cancer drugs and other medicines and explain how they work. A pharmacist will tell you how often to take your drugs. They also explain any care you need to take such as eating certain foods or things to avoid while taking a drug. A pharmacist also tells you about side effects and how to deal with them.
A dietitian teaches you about healthy eating and helps with eating problems that may be a side effect of cancer treatment.
Physiotherapists, or physical therapists, help you maintain or restore a level of fitness through strength and endurance exercises. They teach exercises and physical activities to keep muscles strong and flexible or restore strength and movement.
The role of the social worker is to promote the social functioning of the patient. The social worker works with the patient and his family. He or she may also assist the patient with procedures for obtaining financial assistance required during cancer treatments. The social worker also works with the healthcare team to organize the patient’s discharge from the hospital with the help of resources in the community (CLSC, rehabilitation centres, etc.)
The spiritual advisor offers religious and spiritual support to people who are hospitalized and their loved ones.
The volunteer gives time, energy and services to those who need it. Volunteers play an important role in the support system offered by hospitals.
Your primary treating physician
You will most likely encounter many of these resource people who can help you. However, once a diagnosis of prostate cancer has been established, your primary treating physician will be the urologist. In addition, your family doctor will need to be informed of the diagnosis in order to be able to monitor your overall health. Your urologist is likely to refer you to a radiation oncologist, an oncologist or a palliative care physician.
Is this the right doctor for me?
Une fois que vous avez choisi un urologue, voici plusieurs questions que vous pouvez lui poser si vous êtes en attente d’un diagnostic ou si vous avez reçu un diagnostic de cancer de la prostate.
- Quel pourcentage de votre pratique consacrez-vous à traiter les cancers de la prostate ?
- Combien de prostatectomies radicales faites-vous chaque année ?
- Faites-vous des prostatectomies radicales par laparoscopie ? Suis-je un bon candidat ?
- Quels sont les risques de problèmes de contrôle de la vessie suite à une prostatectomie radicale ?
- Quels sont les risques de problèmes érectiles (avoir ou maintenir une érection) après une prostatectomie radicale ?
- Offrez-vous la radiothérapie externe et la curiethérapie ?
- Quels sont les critères d’un bon candidat à la curiethérapie ? Suis-je un bon candidat ?
- Quels sont les risques de problèmes de contrôle de la vessie suite à une radiothérapie ou une curiethérapie ?
- Quels sont les risques de problèmes érectiles (avoir ou maintenir une érection) suite à une radiothérapie ou une curiethérapie ?
- En quoi consiste l’hormonothérapie ?
- Quels sont ses effets secondaires ?
- Quel type de chimiothérapie utilise-t-on pour traiter le cancer de la prostate ?
- Quels sont ses effets secondaires ?
- La chimiothérapie est-elle très toxique ?
- Je ne réagis plus aux traitements que je reçois pour le cancer de la prostate. Pouvez-vous m’aider ?
You can also participate in the management of your care by keeping a personal medical record on your health condition and by ensuring that all your doctors receive a copy of your tests results. During each medical visit, you can inform your doctor of your discussions with other specialists. This will facilitate communication between each health care provider responsible for your care.
We are here for you
Our urology healthcare professionals are there to listen, support and answer questions from patients, their families, the general public and healthcare professionals. Feel free to contact them.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, with our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involve to advance the cause.