Paul Nelson, Franktalk Therapy

I was 45 when PSA tests indicated problems with my prostate. The journey to diagnosis took about 18 months and a radical prostatectomy about 3 months after that. Looking back, I am very grateful that at the time I was seeing a therapist to help me deal with typical existential issues facing many middle-aged men. It was my therapist who began talking to me about how we experience trauma. I had not really thought about trauma in mental health—I was probably too busy experiencing it. But it was this experience of the trauma of diagnosis, treatment, and aftereffects which has landed me right where I am today—a psychotherapist specializing in men’s health and male sexual function.

Paul Nelson speaking at the Patient Perspectives program at the 2025 AUA Annual Meeting.

Trauma, in mental health, is defined as “the lasting emotional response that results from living through a distressing event.” This emotional response is characterized by feelings of helplessness, lack of control, anxiety, depression, hypervigilance, fear, and even post-traumatic stress disorder. Some describe trauma as a “loss of equilibrium.” This experience is even in our everyday speech—being thrown for a loop, knocked me off my feet, set me back, etc.

In the cancer experience, traumas are layered upon each other in a dizzying fashion. It is like the ripples in water moving out from a central splash. First there is the cancer diagnosis itself. This is the largest splash that starts the cascade. The next trauma is the treatment: surgery, chemotherapy, radiation, or hormone deprivation. These all have their own trauma. Incontinence is a trauma. Pain is a trauma. For most urological conditions, there is sexual function trauma. The effect on relationships is a trauma. Adjusting to a new normal is a trauma.

This last point cannot be emphasized enough. The goal of getting life back to normal is a lie. Life will never be normal again. Our old life is gone forever and will never come back. This epiphany itself becomes another trauma. We are forced to simultaneously grieve and process multiple traumas in rapid succession.

The role of therapy in the cancer journey is huge. As I worked through my cancer experience with my therapist, I was able to recognize how it was affecting every facet of my life. Cancer affected my roles as husband, father, teacher, employee, friend, brother, son, and now, patient/survivor. I was faced with my own mortality for the first time. The meaning of my life was brought into question.

Yes, medical science is a gift. What was once a death sentence is simply no longer the case. Yet, even though we go on living, we may look the same, it does not mean we are not forever scarred and changed for life. The medical treatment is only part of the battle. It’s a big part. But long after the treatments are finished, after the wounds have healed, after the doctor visits are ended, we are never fully the same. We are left with a different body, a new life to navigate, and a need to rebuild our new self. We are never back to normal.

Therapy must become an essential part of cancer treatment. Not a suggestion, not a card handed to a patient, not an afterthought. Trained therapists need to be embedded in every medical setting as simply part of treatment.

As a therapist for the last 12 years I have been part of a men’s health center. I see every patient for a psychiatric evaluation and begin to coordinate their mental health care during their treatment. Many men never need to see me again. But for many, while they begin their medical treatment regimen, they also begin their healing journey. Together we mourn their losses. We have the funerals. We begin to heal the trauma.