Prostate cancer and QOL: Impact of treatment, disease burden and psychosocial interventions

Prostate cancer is highly prevalent and the second leading cause of cancer-related deaths in American men. Treatment of localized prostate cancer is highly effective but can result in urinary, bowel and sexual dysfunction, undermining quality of life. Within 5 years of treatment, approximately a third of men will have a rising prostate-specific antigen level necessitating hormonal therapy which has a broad range of detrimental side effects. Moreover, the impact of hormonal therapy may overlay existing issues (e.g., comorbid illness) common to older men. Men with advanced disease experience significant disease- (e.g., metastasis) and treatment-related impairments, which may further compromise quality of life. A substantial amount of literature indicates that cancer patients benefit significantly from psychosocial interventions, and psychosocial factors may serve to buffer prostate cancer patients from some disease- and treatment-related decrements in quality of life. While very few randomized clinical trials have been conducted with prostate cancer patients, recent results suggest that such interventions improve coping skills, increase prostate cancer knowledge, reduce treatment-related disruption of daily activities, diminish bother associated with sexual problems and enhance global quality of life. In order to better understand who benefits most from psychosocial interventions, additional studies are needed to more fully assess the potential mediators and moderators of these intervention findings.