Depression and Prostate Cancer

April 7, 2010

In NYC where I live, there’s a sign on the side of a building–on West 72nd Street, to be exact– which claims that “Depression is a flaw in chemistry, not character…”  It is, in my opinion, obvious that depression is NEVER  a flaw in character–what an absurd notion.  But what about the reverse; is it always a flaw in chemistry?  IS IT A FLAW AT ALL?  If it is one, then we must rush to correct it; but perhaps the depressed person–for example, the prostate cancer survivor or his partner–is simply mourning for what is lost, coping with a new and scary landscape, searching for a new identity.  

There has been much recent flap lately in PCa circles about how to cope with the depression that often follows treatment.  Whatever treatment it was:  prostatectomy, seeds, beam radiation, cryo, chemo, hormones, proton beam, even HIFU, it is likely to have changed forever  the way a man lives and experiences himself as a sexual being.  Then there’s the flip-side depression:  the partner’s.  What do you do when you’re the one left back on shore, the one whose body hasn’t forever been altered?  The one, perhaps, whose libido is still active?

Some people are turning to antidepressants, and some doctors are advocating this kind of treatment.  On the man’s side, the fact that many such drugs hardly enhance erectile function should certainly be discussed.  Beyond this, however, what is there in our culture that spurs us on to medicate everything?  

Perhaps the way to cope is to go running or listen to music or redefine yourself as you are now.  Join a community of others who have suffered the same way.  Reach for the person on the other side of the room–or the bed; and don’t be afraid of who you are now. Depression may just be the bridge to the next part of your life.  That’s what I’d say to anyone, post prostate cancer, who reaches first for a bottle of pills.

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Medical Fashion

March 12, 2010

Medicine has its own fashions, and while they rule, they rule.  The healthcare fashion runway (medical journals or labs, clinics, newspapers, websites), features models of its own (the people whose lives have been saved or improved in a noticeable way by one or another treatment or device).  But ways of thinking, like fashions, turn, sometimes on what seems like a research whim, and this year’s wonder device, supplement or brilliant treatment strategy may end up suddenly in the has-bin. 

That’s how it shook down a year or two ago for Hormone Replacement Therapy, last decade’s fountain of youth for menopausal women, now widely considered risky business.  Vioxx went that direction. Antioxidents and Vitamin C. have lost their pizazz, as has glucosamine for arthritis.  Even the unassailable mammogram, once important at forty is considered questionably useful at fifty or beyond.   

Add to the list “P.S.A.,”an acronym that once stood for “Public Service Announcement,” until it became a synonym for worry in men of a certain age whose prostates might possibly harbor cancer. Prostate Specific Antigen, a normal protein in men’s blood that, when elevated, can signal prostate cancer, might also indicate Benign Prostatic Hyperplasia–or nothing. The often painful prostate biopsy that usually follows an elevated PSA, even when it yields positive results, won’t tell you or your doctor whether the prostate cancer in question is one of the fast-moving variety or the other far more common one you’ll die “with, not of.”  

 Mammograms, PSA–these tests cost us all a lot of money, and money is something we ought to be saving, isn’t it? ( starting with overinflated executives’ salaries might be more prudent). But what has really happened is that the optimism surrounding the tests’ universal use has begun to fade. Suddenly it isn’t clear if or why most of us should get them, and statistics aren’t making a case for continuance.

 Well here are two cases:  my sister, whose breast lump was removed at 71, and my husband, whose rapidly escalating PSA might have indicated virulent cancer (we’ll never know).  Almost everybody knows someone who might have died if he or she hadn’t been tested.  But these days,  a kind of “ignorance is bliss” approach surrounds both these cancers; it’s almost  “don’t ask, don’t tell.” 

What’s changed?  Our optimism concerning survival and treatability?  Out with the old  and in with the new:  float another dress down the runway.