If you ask the spouse or partner of a man diagnosed with prostate cancer about the disease and its treatment, you’ll often hear answers in the first-person plural: “We opted for a radical prostatectomy.” “We…
If you ask the spouse or partner of a man diagnosed with prostate cancer about the disease and its treatment, you’ll often hear answers in the first-person plural: “We opted for a radical prostatectomy.” “We thought it was his best chance for a cure.”
That parlance is common among partners of men with prostate cancer, says Dr. Andrew Roth, attending psychiatrist at Memorial Sloan Kettering Cancer Center who specializes in treating men and couples affected by prostate cancer. “There are lots of spouses who will tell me cancer didn’t just hit the husband, it hit (the wife) as well,” he says.
Makes sense. Like all cancer diagnoses, telling a man he has prostate cancer can force him — and his loved ones — to confront his mortality for the first time. But unlike many other cancers, prostate cancer often has a direct effect on the significant other, particularly in the form of erectile dysfunction, a common (albeit often temporary) side effect of treatment, according to the Prostate Cancer Foundation. “Erectile dysfunction is not only affecting the patient, it’s affecting the patient and the partner,” says Dr. Mohit Khera, professor of urology at Baylor College of Medicine. “That’s very obvious.”
Less obvious is how the diagnosis can influence a man’s mental health and, in turn, his relationship. A 2014 review of 27 studies published in the journal BMJ Open concluded that “the prevalence of depression and anxiety in men with prostate cancer, across the treatment spectrum, is relatively high.” “The diagnosis of cancer has a psychological impact on the body and mind,” Khera says.
Some side effects of treatment like incontinence can also influence a man’s behavior, adds Roth, also a professor of clinical psychiatry at Weill Cornell Medical College and author of the book “Managing Prostate Cancer: A Guide for Living Better.” “(Men) may not feel comfortable socializing, and so spouses will believe he must be depressed,” Roth says, “but he’s actually just anxious and doesn’t know how to deal with it.”
On the upside, it’s possible for the mental health and relationships of survivors to actually improve after prostate cancer, says Dr. Scott Eggener, professor of surgery at The University of Chicago Medicine, where he directs the Prostate Cancer Program and is co-director of the High Risk and Advanced Prostate Cancer Clinic. “Most men that go through treatment end up on the other side with a great quality of life, and their relationship is the same — sometimes even better because they have a new perspective on the important things in life,” he says.
Here’s what experts suggest you do if your significant other is diagnosed with prostate cancer:
Get the facts.
Prostate cancer is the most common type of cancer among men after skin cancer, affecting 1 in 9 American men in their lifetimes, according to the American Cancer Society. The majority of diagnoses are among men over 65 years old, and prostate cancer is rare before age 40, ACS reports. While the disease will take about 31,620 American lives in 2019, ACS estimates, most diagnosed men don’t die from it. About 90% of prostate cancers are discovered in the early, so-called localized or regional stage, and the five-year survival rate for those cases is nearly 100%. The survival rate for all stages of prostate cancer is about 98%, the ACS reports. Plenty live with it, and those who choose to treat prostate cancer generally have “very good” outcomes, Khera says. “This cancer is very treatable.”
Depending on its stage, prostate cancer treatment options can range from not intervening at all to undergoing surgery or radiation. If the cancer has spread too far to be treated with surgery or radiation, men may choose hormone therapy, which aims to reduce the male hormones affecting the prostate cancer cells through drugs, or surgery that removes the testicles.
Whatever you choose, keep in mind that there’s no right or wrong treatment — if there was, all experts would agree on one, Roth points out. In retrospect, “(couples) probably made the best choice they could have made,” he says. You never know if another choice would have resulted in a worse outcome.
If the cancer doesn’t need immediate treatment, be sure to meet with at least one other medical professional before deciding how to proceed, Eggener advises. “It’s always a good idea to get second opinions and hear about all the options,” he says.
However, consider that doctors’ recommendations are likely influenced by their specialty: The radiologist might push for radiation therapy while the urologist might be more likely to suggest surgery. Therefore, you may want to meet with both types of doctors to hear what each has to offer.
Even once you decide on a treatment, shop around for a provider with that expertise, Khera suggests. When it comes to surgery, he says, the more experience the better.
Ask to be his second set of ears.
How men react to learning they have prostate cancer is as different as the men themselves. “Some men have been perfectly healthy up until that point, and it’s really an awful experience to be told, ‘You have cancer,'” Eggener says. “Other men kind of roll with it.”
Either way, learning about treatment options, risks and statistics is a lot for anyone to absorb. That’s why it can be helpful to act as your partner’s second set of eyes and ears at doctor’s appointments and meetings with potential providers. “Two heads are better than one,” Roth says, the exception being if you’re more anxious than your spouse. In that case, encourage him to bring another friend or relative and offer to help in another way, such as scheduling his appointments, he suggests.
Still, some men may want to handle the doctor visits themselves. In that case, experts suggest the spouse or partner let him know that you’re there for him and that you want to help, but understand that sometimes, he has to take the lead in his own care. If the man does wish the partner to tag along, it’s a good idea to bring a pen and paper to appointments or even to ask to audio record discussions, in order to gather and remember important information.
Patience is a virtue. Prostate cancer is a lot to deal with. It affects manhood, the side effects may be embarrassing, and men may not feel comfortable talking about it. Instead of taking offense, respect those issues and feelings.
Some men experience physical side effects like erectile dysfunction even before treatment begins, Khera says. During and after treatments, men may experience mood swings from hormones or not want to have sex because they’re embarrassed about incontinence. “The partner needs to realize it’s not her,” Khera says.
Still, it’s important to let your partner know he’s desired. Roth recommends fostering intimacy, even if that simply means massaging each other or cuddling. When it comes to penile rehabilitation after surgery, at least, “the partner’s involvement in recovery of sexual activity is important,” Khera says.
Seek professional help.
When Roth goes into the waiting room to call a man with prostate cancer into therapy, usually two people stand up: the patient and his spouse. So long as the man is OK with it, Roth says he welcomes them both. “Their communication has probably hit a rut,” he says. It’s his job to coach them through it, perhaps by helping a woman recognize that saying “Don’t worry, everything will be fine!” isn’t always welcomed. “It’s well-intentioned, but the guy is thinking, ‘How do you know?'” Roth says. If you’re feeling frustrated or overwhelmed by how the diagnosis has changed your relationship, don’t hesitate to turn to a therapist or other professional to help you work it out.
Take care of yourself.
The partner of a man with prostate cancer is often the one listening to his fears, coping with his mood swings, preparing his meals and being “the cheerleader. But that partner also has fears and anxieties. That’s why it’s important to cultivate your own support system, be it through friends, support groups through local hospitals or online forums for spouses and other partners like you. Remember, you can’t be there for your man if you don’t take care of yourself.