Prostate Cancer Treatment and Depression

Introduction

The American Cancer Society, the umbrella body that brings together cancer patients and oncologist, prostate cancer is the most common type of cancer in the United States of America. Prostate cancer is most common in the United States of America than in other countries in the world such as Asia and Africa. For example, in the year 2008 alone, more than 186,000 men in this country were diagnosed with this condition (Sartor et al, 2008). More than 28,600 men in this country died from this disease.

In terms of mortality, prostate cancer is the second most common cause of death in men in this country, following closely after lung cancer (Djulbegovic, Beyth, Neuberger, Stoffs, Vieweg, Djulbegovic & Dahm, 2010). The trend is similar in other developed nations, with developing nations such as those in Africa recording low mortality rates. Some experts attribute these apparent high cases in the United States of America and other developed nations to high rates of detection in the countries. This is given the fact that prostate cancer can go for a long time without being detected. As such, in the developing nations, men might be suffering from this condition without their knowledge. The high rates of prostate cancer diagnosis in the United States of America and other developed nations is also attributed to the high life expectancy in these regions than in other regions of the world, especially the developing nations. This is especially so given the fact that prostate cancer affects men who are aged fifty years and above.

There are several types of treatment models that are used to manage prostate cancer, and the type of model adopted depends on factors such as the advanced stage of the condition. The type of treatment adopted also depends on the physiological status of the patient. These models include watchful waiting and surveillance, surgery, radiation and hormonal therapy among others.

Prostate cancer, just like any other significant conditions in the society, affects not only the physical health of the patient, but also their mental and psychological wellbeing. For example, Andviole et al (2004) argues that depression is such one psychological impact of prostate cancer on the patient.

It is important to note that the psychological effects of prostate cancer are not limited to the patients alone. Other people around them such as family members and spouses are also affected. This is especially so given the fact that prostate cancer is more or less a couple’s disease.

The various treatment models as identified earlier are accompanied by varying degrees of depression. This is given that some of the treatment models are so invasive and tend to encroach into other spheres of the patient’s life. The aim of this paper is to look at the various prostate cancer treatments and the varying degrees of depression that coincides with each treatment. To this end, this author is going to identify the various treatment models of this condition, then map out the possible and actual depression levels that go with it.

Different Levels of Depression

Before looking at the specific prostate cancer treatment methods and the riding levels of depression, it is important to look at the various levels of depression that have been identified by psychologists and psychiatrists in the field. These are the levels of depression that will be used when analyzing the various treatment methods for prostate cancer. Looking at these levels of depression at this level will provide a context for the discourse that will follow later on in the paper.

The chart below depicts the various classifications of depression by psychiatrists:

Chart 1: Classification of Psychiatric Disorders

Psychiatric Disorders Chart

Level 1 – Psychosis
Mode of intense sadness and misery. Contact with reality is distorted. Delusions/hallucinations
Level 2 – Neurosis
Extreme form of misery going beyond what would be regarded as normal for the circumstances
Level 3 – Personality disorder
Someone who stands out from the average person by virtue of one or two character traits.
Level 4 – Normal reaction
Depressive illness or anxiety neurosis will not clear, even if the trigger is removed.

Source: Freedland et al (2008)

Mild Depression

This kind of depression is classified as level three and four of psychiatric disorders (Lu-Yao et al, 2009). It can be described as anxiety, fears and stress triggered by certain events in the life of the person. It involves fear of the unknown and unnecessarily worrying. It is mild and can be managed by removing the triggers causing it.

Moderate Depression

This kind of depression affects the functionality off the individual both at home and at the workplace (Freedland et al, 2008). This is what psychiatrists will refer to as neurosis, which falls at the second level in the classification above.

Severe Depression

This kind of depression makes the individual to lose touch with reality (Freedland et al, 2008). The functionality of the individual is severely affected. The sufferer exhibits signs of delusions and hallucinations. This can be classified as psychotic in the chart above.

Reactive Depression

This is also referred to as endogenous depression. This is the form of depression that emanates from an occurrence from without the individual. This is for example death or separation in a family. Most depressions caused by prostate cancer falls under this category, but they differ in their severity (Leitzmann et al, 2004).

Different Treatment Methods for Prostate Cancer and Levels of Depression

As earlier indicated, there exists different types of treatment for prostate cancer, and the selection of a particular treatment depends on various factors from within and from without the patient. The different treatment models have different levels of depression, given that the psychological wellbeing of the patient is severely affected at times.

The following are some of the symptoms of depression that manifest themselves in patients undergoing treatment. The severity and combination of these symptoms determines the severity and level of depression that the patient is undergoing:

Sleep Disturbances

The treatment may affect the sleeping patterns of the patient (Sartor et al, 2008). For example, the patient may sleep too much or too little than normal. They spend most of their waking hours in depressive thoughts about their condition.

Lack of Energy and Concentration

The patient may feel fatigued most of the time even when they have done little or nothing. They may also have problems focusing on what they are doing, and at times they make irrational decisions.

Suicidal Thoughts

Due to the ailment, the patient may experience sense of helplessness and uselessness. It is during such low moments that they entertain suicidal thoughts, having lost the will to live (Korfage, Essink-Bot, Janssens, Schroder & Koning, 2006).

The following are some of the treatment methods for prostate cancer:

  • Watchful Waiting and Surveillance. This involves a close monitoring of the sufferers condition with no medication involved (Djulbegovic et al, 2010). The surveillance of the condition is continued until the symptoms for the condition manifest themselves or shift. Smith, Chan & Chang (2007) are of the view that it is usually the older men that receive this kind of intervention. This is especially so if the old man has other underlying medical conditions that may interfere with medication, such as heart complications. Watchful waiting is also used when the oncologist detects the disease at its early stages, and they are waiting to see how it will develop to adapt another treatment method. At this stage, the patient is filled with a lot of uncertainties, since they do not know what may happen next. Depression in such state is inevitable. The patient losses interest in activities that they were hitherto enjoying (Miller, Hafez, Stewart, Montie & Wei, 2003). This includes loss of interest in sex, and the patient is filled with a sense of worthlessness. They may also withdraw from interactions with family members and friends.
  • Surgery.Wigle (2008) is of the view that this form of treatment is usually reserved for those patients that are in good health, with mild or no underlying conditions. There are different types of surgery that are offered to these patients depending on the severity of their condition.
    • Pelvic Lymphadenectomy. This, according to Korfage et al (2006) involves the removal of lymph nodes that are situated in the pelvis. This is especially so if the lymph nodes of the patient already have cancerous cells. The prostate is not removed during this procedure.
    • Radical Prostatectomy. This is the removal of the prostate gland and surrounding tissues such as seminal vesicles (Miller et al, 2003: Hankey et al, 1999). This may be performed through two ways. The first is retropubic prostatectomy, which involves incision in the abdominal wall (Zeegers, Jellema & Ostrer, 2003). The other is perineal prostatectomy. This involves an incision in the perineum through which the prostate gland and if necessary the surrounding lymph nodes are removed.
    • Transurethral Resection of the Prostate. This involves the surgical removal of tissue from the prostate gland (Hoffman et al, 2001). The surgeon makes use of a resectoscope which they insert through the urethra (Hoffman et al, 2001). This procedure is especially recommended when the oncologist is of the view that symptoms emanating from the tumor need to bee relieved to make way for the administering of other treatments such as use of drugs. This is also recommended for those patients who are, due to age or underlying conditions, unable to withstand radical prostatectomy (Zeegers et al, 2003).

Depression emanating from this kind of treatment is mainly caused by the side effects of the surgery. Due to the surgery, the patient may experience impotence. This is especially so if the nerve endings responsible for erection are affected or severed during the surgery. This makes the patient feel like an incomplete man, and feelings of helplessness may lead to suicidal thoughts (Martin, Vatten, Gunnell & Romundstad, 2010). This may be aggravated when the relationship between the man and his spouse is strained due to his inability to function sexually. The patient is not only affected by the devastating effects of the surgery, but also by the emotional burden of dealing with their spouse’s demands.

Even before the surgery, the patient may have been affected by reduced libido and impotence. This is given the fact that impotence is one of the major effects of prostate cancer.

The surgery may also lead to leakage of urine and stool from the patient’s bladder and rectum (Peters et al, 2007). This is especially so if the surgery interferes with the sphincter muscles of the rectum and the bladder. This development is very humiliating to the patient. As a result of this, they might go into depression and withdraw from any social interaction with their friends and their family members.

Surgeons may try to elevate the effects of the procedure on the sexual functionality of the man (and hence the resulting depression) by adopting a surgical procedure referred to as nerve sparing surgery (Schulman, Ekane & Zlotta, 2001). This is whereby the surgeon takes precaution to ensure that the nerves controlling erection in the man are not severed. But this can not bee carried out in patients that have very big tumors which may be located near the nerves (Schulman et al, 2001).

Other effect of surgery that may be devastating to the patient is the shrinking of the penis that takes place as a result of the prostatectomy (Schulman et al, 2001). The explanation for this one to two centimeters reduction may not be clear to the medical fraternity, but the effects on the psychological wellbeing of the patient is obvious. The self esteem of the patient may be impacted on by this effect on their penis. This may drive them into depression.

There are other effects such as inguinal hernia that may result from the surgery. This condition involves the bulging of fatty tissue or sections of the small intestine through weakened muscles into the groin of the patient (Brinkman et al, 2006). This is especially so for those patients who have undergone radical prostatectomy. The condition occurs mostly within the first two years following the surgery (Brinkman et al, 2006).

Inguinal hernia may cause depression to those men who are very conscious of their looks. They may feel humiliated by the development and develop low self esteem.

Radiation Therapy

The aim of this kind of therapy is to destroy cancerous cells in the body using high energy x-rays and other forms of radiation (Duffield-Lillico et al, 2002). Apart from destroying the cancerous cells, radiation also aims at averting their growth and replication.

There are two types of radiation that are used to treat prostate cancer and other forms of cancers in human beings. The first is external radiation, and it involves the use of a radiation machine placed outside the body of the patient (Duffield-Lillico et al, 2002). The machine is operated in such a way that it focuses its radiation on the cancer. The other type of radiation is internal radiation. This involves placing radioactive elements enclosed in needles, catheters and such other tools which are then placed directly into the cancer or within the locality of the same (Davison, Joyce, Degner & Lesley, 1997).

The mode of radiation therapy used on the prostate cancer patient and other cancer patients depends on the location of the tumor and the stage of its development. Just like in surgery, this mode of treatment has specific effects that may potentially lead to depression. Radiation therapy increases the risk of bladder and rectal cancer (Davison et al, 1997). This may cause anxiety to the patient, and the uncertainty of what to expect after the radiation therapy may lead to depression. It is important to note that one of the symptoms of depression is the fear of the unknown, and this is one trait that is observable in prostate cancer patients.

Radiation therapy may cause impotence and urinary complications, developments that may affect the psychological wellbeing of the patient. Urinary problems such as bladder incontinence may embarrass the patient, making them withdraw from social interactions.

Hormone Therapy

The aim of this form of therapy is to stop the growth of cancerous cells in the body. This is achieved by eliminating hormones that encourage the growth of the cells or blocking the action of those hormones altogether (Carlson, Speca, Patel & Goodey, 2003).

Male sex hormones such as androgen may be the cause of the prostate cancer in the patient. Hormonal therapy using drugs, surgery or administration of other forms of synthetic hormone is aimed at lowering the secretion of androgen and other hormones in the patient or stopping their actions in the body (Carlson et al, 2003).

Hormonal therapy also has a number of side effects that may affect the emotional stability of the patient. For example, the sexual life of the patient may be affected by reduction in levels of libido and total lack of sexual desire. The patient may go into depression when they try to think about the reactions of their spouse towards their condition. Weak bones, pruritus and diarrhea may be other side effects of hormonal therapy that may lead to depression on the part of the patient. These side effects negatively impact on their social life, and they may start to withdraw from all social interactions around them.

Chemotherapy

The oncologist may opt to use drugs to treat a particular prostate cancer patient. The drugs are used to inhibit the growth of the cancerous cells by destroying them or inhibiting their division and multiplication throughout the body (Lu-Yao et al, 2009).

The drugs may affect the natural functioning of the patient’s body. For example, they may lead to impotence and such other conditions that may lead to depression. Aggressive chemotherapy may also affect the interpersonal relations of the patient, alienating them from the social life around them. This isolation drives the patient further into depression.

Conclusion

The five types of treatment analyzed above are not the only ones used to treat prostate cancer. There are other treatment plans such as biologic therapy, cryosurgery and high intensity focused ultrasound. Some of these treatment types are fairly recent and are still under clinical trials.

However, despite the type of treatment that is used, it is important to note that the outcomes of the treatment, and in some cases the procedures of treatment, may cause severe depression in the patients. The level of this depression varies from one patient to the other and from one mode of treatment to the other. Oncology experts have noted that some off these depression bouts are so severe such that the patient needs to be put under a separate treatment specifically for depression. In conclusion, it is pertinent to note that prostate cancer patients should be on the look out for any sign of depression. This is given the fact that prostate cancer puts not only the patients under the risk of depression, but also their family members.

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