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.


Life Without P.S.A. Screening: Russian Roulette?

March 10, 2010

Millions of men woke this morning to the news that what had been done to their bodies in the name of stopping prostate cancer, may after all have been “a mistake.” Writing in The New York Times (Tuesday, March 10, 2010), Dr. Richard J. Ablin, who discovered prostate specific antigen in 1970, calls the routine use of P.S.A. to screen for prostate cancer “hardly more effective than a coin toss.” He points out (as many health-care professionals have been unwilling until recently to admit) that men, post treatment, “…in all likelihood can no longer function sexually or stay out of the bathroom for long.”

American men have, according to recent statistics, a 16 % lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 % chance of dying from it, because most prostate cancers are slow-growing:  the cancer you die with, not of.

Dr. Ablin admits, as we all know, that, so far, we can’t distinguish between the cancer that will kill you and the one that won’t.

Who is the “you” in the previous paragraph?  A statistic or a real flesh-and-blood man?

How does Dr. Ablin imagine it feels to wake up and read that your life-altering treatment has been a mistake? What is a statistic to a life?  How many men with rapidly-escalating P.S.A.’s had Gleason Scores of 7 or above and are alive today as a result of this test? Admittedly, my own husband, whose Gleason was a routine 6, might well have been unnecessarily treated, although his P.S.A. velocity at the time of prostate cancer diagnosis was notable.

It may be that Dr. Ablin’s metaphor, the coin toss, is off the point. It has been said that generally one in ten men with a positive biopsy has a fast-moving prostate cancer that will kill if left untreated.

Universal P.S.A. screening may be a coin toss; but its absence returns us to Russian Roulette. P.S.A. tells us that it might be cancer, and if so, a virulent bullet might be in one of several chambers. Surely knowing this is so, and going for a biopsy, painful as it is, is more valuable than ignorance. If, as Dr. Ablin suggests, “testing should absolutely not be deployed to screen the entire population over the age of 50,” then my husband, among others, might have waited long enough to hear the word “metastasis,” or the even more chilling, the words, “your cancer has gone to bone.”

If P.S.A. as a universal screening tool is inappropriate, then rather than scrapping it for the general population, perhaps doctors should learn to educate their patients and partners to the real truth about the likely sexual, urinary and even bowel consequences of treatment. Then men can make a truly informed choice, as many European men do, who choose to watch and wait.

As long as men are alive who have received these treatments in good faith, Dr. Ablin’s argument stands as the ultimate insult to their experience. He shames what he calls profit-driven public health initiatives, but there are men whose lives have been spared, and those lives are worth something after all. The real shame lies in valuing statistics over individuals.


the dark undiscussed corner of male sexuality

March 4, 2010

Why is libido the dark undiscussed corner of male sexuality?  If you read Dana Jennings’ blog on the The New York Times website, he talks about libido as distinct from erectile function, but not many other men who are prostate cancer survivors do. And yet, women who suffer from sexual dysfunction talk mainly about their libidos. It would seem that for men sexuality is forever linked to the mechanics of the penis, so much so that libido is cast aside and forgotten.

There is a great difference between the desire to have traditional sex and the ability. Of the two, the greater and subtler challenge is desire: without it, even a man who has solved the problem of mechanics via pills, a prosthesis or a vacuum device is likely to have a hollow or ironic experience.

Out of the corner of his eye, my husband saw me in a revealing blouse, and it did something. But the lovely moment vanished, and we haven’t been able to get anything like it back for months. Dana Jennings describes similar moments. That’s how it is. There are a lot of guys out there with zero motivation on account of hormone ablation, which keeps the body from producing testosterone. In some men the loss of libido post hormone treatments is permanent; in others temporary. Nobody knows why.  Only recently have some  doctors begun to discuss these effects frankly with their patients before treatment. Each of us—both Pca men and the partners who live with them—has a different thing to struggle against…what an intricate process cancer survival can be.