The diagnosis and subsequent treatment of cancer is a major life stress that is followed by a range of well-described psychological, social, physical and spiritual difficulties. Men with advanced prostate cancer where curative intent is no longer the treatment goal, face distinct challenges compared with men with localised prostate cancer. As outlined in these guidelines, the iatrogenic effects of hormonal ablation include mood disturbance, cognitive impairment, hot flushes, osteoporosis, fatigue, sexual dysfunction, and changes in muscle mass and adiposity. Men with advanced prostate cancer face the dilemma of choosing not only a specific treatment, but also the timing of treatment initiation and the difficult task of weighing up the pros and cons of various approaches. Decision support is particularly salient given most men with prostate cancer prefer active involvement in decision making about treatment. Further, in comparison to men with localised prostate cancer, men with advanced disease report higher levels of psychological distress, poorer quality of life and greater unmet supportive care needs. As well, partners of men with prostate cancer report high levels of psychological distress than are experienced by the men themselves. Hence, guidance is crucial for men with advanced prostate cancer and their families on steps to maximise quality of life and to enhance and protect interpersonal relationships.
Peer support through the Prostate Cancer Foundation of Australia and state-based Cancer Councils is currently broadly available. In a large Australian cross-sectional survey of group members, this type of support was positively endorsed by men as a helpful source of emotional and informational support. This is mirrored in similar studies elsewhere.However, to date there are significant limitations in research into the psychosocial aspects of prostate cancer. Limitations include the use of small convenience samples, cross-sectional designs, limited follow up, and a general failure to adhere to CONSORT (CONsolidated Standards of Reporting Trials) guidelines. In the case of advanced prostate cancer there is scant intervention research that specifically targets the concerns and needs of these men and their families. As a result, the scope of this review was by necessity extended to studies of men with localised or mixed-stage disease, and their partners where possible. There is an urgent need for research, health policy and planning to focus efforts and attention specifically on men with advanced prostate cancer and their families.
- In men with prostate cancer, do interventions improve decision satisfaction, risk comprehension, knowledge about prostate cancer and understanding of their prognosis?
- In men with prostate cancer, do psychological and cognitive interventions improve psychological adjustment?
- In men with prostate cancer, do diet and lifestyle interventions improve quality of life?
- In men with prostate cancer, do interventions improve sexual functioning?
- In men with prostate cancer, do interventions alleviating partner distress improve quality of life?
Questions, for which no systematic review undertaken and were dealt with descriptively:
- What are the levels of psycho-social distress in men with advanced prostate cancer, including that related to PSA anxiety?
- What are the unmet supportive care needs of men with advanced prostate cancer? - with particular focus on Australian men -> see above introduction
Issues requiring more clinical research study
Clinical questions considered, but for which no evidence was found during systematic review
- Green HJ, Pakenham KI, Headley BC, Yaxley J, Nicol DL, Mactaggart PN, et al. Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial. BJU Int 2002 Sep;90(4):427-32 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12175403.
- Davison BJ, Goldenberg SL, Wiens KP, Gleave ME. Comparing a generic and individualized information decision support intervention for men newly diagnosed with localized prostate cancer. Cancer Nurs 2007;30(5):E7-15 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17876177.
- Flynn D, van Schaik P, van Wersch A, Ahmed T, Chadwick D. The utility of a multimedia education program for prostate cancer patients: a formative evaluation. Br J Cancer 2004 Aug 31;91(5):855-60 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15280915.
- Steginga SK, Occhipinti S, Gardiner RA, Yaxley J, Heathcote P. Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer. Urology 2004 Apr;63(4):751-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15072894.
- Wong F, Stewart DE, Dancey J, Meana M, McAndrews MP, Bunston T, et al. Men with prostate cancer: influence of psychological factors on informational needs and decision making. J Psychosom Res 2000 Jul;49(1):13-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11053599.
- Eton DT, Lepore SJ. Prostate cancer and health-related quality of life: a review of the literature. Psychooncology 2002;11(4):307-26 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12203744.
- Steginga SK, Pinnock C, Gardner M, Gardiner RA, Dunn J. Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory. BJU Int 2005 Jan;95(1):46-50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15663527.
- Steginga SK, Occhipinti S, Dunn J, Gardiner RA, Heathcote P, Yaxley J. The supportive care needs of men with prostate cancer (2000). Psychooncology 2001;10(1):66-75 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11180578.
- Couper J, Bloch S, Love A, Macvean M, Duchesne GM, Kissane D. Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature. Psychooncology 2006 Nov;15(11):937-53 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16521081.
- Dunn J, Steginga S K, Rosoman N, Millichap D. A review of peer support in the context of cancer. Journal of Psychosocial Oncology 2003;21(2): 55-67.
- Bloch S, Love A, Macvean M, Duchesne G, Couper J, Kissane D. Psychological adjustment of men with prostate cancer: a review of the literature. Biopsychosoc Med 2007 Jan 10;1:2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17371571.
- Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001 Apr 17;134(8):663-94 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11304107.