Prostate cancer affects the lives of many men in different ways, but overall, their quality of life and wellbeing are severely hampered (Holm et al, 2018), particularly in the final years before death. Although most men continue to live long with prostate cancer following treatment, they experience a number of challenging symptoms, both physical and psychological, including anxiety; pain; guilt; the inability to have an erection; and feeling rejected, alone, lonely, worried and angry, all of which may impact on their sexuality and intimacy.
Although sexuality and intimacy are often used interchangeably, a fine difference can be articulated, as follows. Sexuality refers to how individuals feel about and express themselves sexually. It must be emphasised that sexuality is not just about sexual intercourse, but also about sexual desire and engaging in activities of a sexual nature, such as enhancing one's appearance, femininity or masculinity. This also includes the preference of non-binary individuals to be referred to as ‘they’. On the other hand, intimacy is about sharing love, affection and warmth, which can be achieved through touch, kissing, hugging etc. The point here is that men living with prostate cancer may not always be comfortable talking about their sexuality and may not engage in intimacy with their partners either.
Normally, after receiving a diagnosis of prostate cancer, men might experience a range of emotions: fear, anger, shock, guilt and psychological loneliness (Holm et al, 2018). What health professionals need to understand is that because of these emotions, men may shut themselves off and, as a result, fail to engage in sexual and intimate activities with their partners. As the cancer progresses, other more frightening emotions may be experienced, for example, dealing with new people and situations and not knowing what to do (psychological paralysis), just to name a few. Evidence suggests that these and other emotions, might, if ignored, lead to poor patient experience through their cancer trajectory (Holm et al, 2018). The main impact is on the person's wellbeing, which results in poor quality of life. Community health professionals play an important role in supporting these patients to restore their wellbeing and enhance quality of life in the home. This is no easy task, as the number of men diagnosed with prostate cancer is now quite high: The UK reported 47 600 prostate cancer diagnoses in 2016 (Cancer Research UK, 2016), and prostate cancer accounts for 26% of all new cancers. In Australia, 21 000 men are diagnosed each year, and prostate cancer accounts for 30% of all new cancers (Cancer Australia, 2019). Sweden reported that 10 439 men were diagnosed with prostate cancer in 2015, with 23% dying from the disease (Holm et al, 2018).
Although the survival rates are quite high (an 84% survival rate is achieved in the UK), it can be argued that this figure needs to be improved further.
The research by Holm et al (2018), which studied a stratified sample of 3885 men, concluded that many rated their quality of life as poor. According to the World Health Organization, quality of life is the main concern, along with pain and symptom control (Murray et al, 2005). Admittedly, any cancer trajectory is similar and that of prostate cancer is no different, being characterised by predictable worsening of health and wellbeing and increasing severity of symptoms such as fatigue and pain in the final year of life.
What is important to consider—and which is often missed—is the impact of the more subtle yet dangerous symptom of loneliness. The ‘danger’ of loneliness intensifies when men dwell on mental replays of all the negative outcomes and possible outcomes, such as being unable to have intimate relationships, perpetual discomfort, frustration, feelings of guilt and poor physical functioning (Holm et al, 2018). Frustration is often intertwined with anger, which men try to suppress but often manifests as sadness and resentment towards all the things they are now unable to do.
Men living with prostate cancer and in the final year before death may benefit from a palliative care approach that aims to balance life-prolonging treatments with those ensuring the best-possible quality of life. Information helps patients participate in decisions about the best treatment and care options for them that will also enhance wellbeing and quality of life.