Background

Recent studies reveal that men diagnosed with prostate cancer are up to 1.7 times more likely to die by suicide than men not so diagnosed.¹ This is a story of how I avoided becoming part of this statistic.

I was diagnosed with prostate cancer in January, 2010, at age 58, at a world-renowned Chicago teaching and research institution (“University”).

Biopsy revealed 1 core of low-volume Gleason 3 + 4 disease. I wanted to do active surveillance, but was told by University urologists that this was not an option due to my age and the presence of Gleason 4 disease, and that surgery and radiation were my only options. I was assured that I could be expected to recover fully and quickly from surgery due to my good physical condition (I was in the process of training for a marathon) and age.

I reluctantly agreed to surgery, which was performed as an open procedure by world-renowned University urologist, Dr C. At the time of my surgery, I was told that Dr C had performed more than 5000 radical prostatectomies.

Post surgery, I recovered rapidly except for sexual function, particularly orgasm, sensation, and erection. About 5 months postoperatively, I developed extreme frustration and anger concerning my sexual functioning. I did not realize this was part of a clinical depression until I became suicidal.

Approach

I emailed Dr C and asked him whether I was doing everything possible to regain my sexual functioning. I admonished him not to advise me again to be patient because it made me want to ride my motorcycle off a bridge. I concluded by asking whether he thought a mental health referral was in order. To my astonishment, he replied that he had never had to make a mental health referral (presumably in connection with, among other things, the more than 5000 radical prostatectomies he had performed by that time). Despite his response, he made a psychiatric referral for me the same day to a University psychiatrist, who prescribed medication and arranged for cognitive therapy with a University therapist. This and participation in support groups put me on the road to recovery, and I fairly quickly abandoned suicidal ideations.

Maintenance

About a year later, I saw Dr C for a follow-up appointment. At the end of that appointment, I remarked that I was kind of proud to be his first mental health referral. He replied that he was making mental health referrals and, in fact, had made one the previous week.

Quality of Life

Professional mental health care was essential to improve my quality of life or even potentially save my life. For me, Dr C’s acknowledgment that he was making mental health referrals remains one of the few bright spots in my prostate cancer journey, and underscores how a simple conversation between patient and urologist can improve patient care and quality of life.

In addition, this experience as well as almost 14 years of working to support prostate cancer patients have taught me the following:

1. Patients need to be their own best advocates and not be afraid to ask for help.
2. Urologists need to take the time to ascertain patient goals and priorities and help them develop reasonable treatment expectations to avoid treatment regret and resulting depression and other mental health issues.
3. One patient/urologist conversation can make a huge difference for the patient as well as bring about changes in practice that benefit other patients.
4. Peer support groups are very important to patients throughout the prostate cancer diagnosis, treatment, and recovery process. Among other things, they can help patients make informed treatment decisions and avoid treatment regret and depression.
5. At a minimum, every urologist should identify mental health professionals and peer support groups to which patients can be referred for immediate help.
6. Urologists need to monitor their patients for mental health issues and make appropriate and timely referrals to mental health professionals and support groups. This will not require that urologists act as mental health professionals, but rather that they simply monitor patients using readily available tools to help identify mental health issues that are appropriate for referral. It is critical that urologists initiate the conversation. Patients suffering mental health issues cannot be forced to rely solely on self-help for timely mental health care.
7. Mental health is a huge issue for prostate cancer patients, and it is not on the radar screens of many, or most, urologists. Best practices for mental health need to be embodied in official guidelines to get the attention of urologists and improve mental health care for prostate cancer patients.