Body Image and Quality of Life in Men With Prostate Cancer

Joanne M. Harrington, PhD, APRN, BC, AOCNP; Terry A. Badger, PhD, RN, FAAN

Disclosures

Cancer Nurs. 2009;32(2):E1-E7. 

In This Article

Abstract and Introduction

Abstract

Each of the successful treatment options for men with prostate cancer is accompanied by its unique side effect profile. However, treatment with androgen deprivation therapy (ADT) and the resulting castrate level of testosterone lead to profound changes in one's physical appearance. The goal of this descriptive study was to describe the relationship between changes in body image and quality of life (QOL) among prostate cancer survivors based upon whether or not treatment was with ADT. A convenience sample of 132 men (aged ≥60 years) with prostate cancer were recruited from the oncology and urology outpatient departments at an urban Veterans Affairs Medical Center. The participants completed 2 established questionnaires, the Body Image Scale and the Quality of Life Index-Cancer Version. Descriptive and inferential statistics were used in the analysis. There was no difference in QOL based on ADT. There was a significant negative correlation between body image dissatisfaction and QOL. The findings add to our knowledge regarding body image and QOL among men with prostate cancer, provide a foundation for future research endeavors, and support the development of evidence-based interventions to mitigate body image dissatisfaction.

Introduction

It is estimated that more than 186,320 men will be diagnosed with prostate cancer[1] in 2008. Prostate cancer represents 25% of all cases of cancer in men. Men with prostate cancer comprise a significant percent of the cancer survivor population because the difference between incidence and mortality is large. The relative 5-year survival rate is 98%, and most men diagnosed and treated for prostate cancer survive for many years.

Although each of the successful treatment options for men with prostate cancer (surgery, radiation therapy, watchful waiting, or hormonal therapy)[2] is accompanied by quality of life (QOL) implications, it is the side effect profile associated with androgen deprivation therapy (ADT) that is of particular interest. Currently, about one-third of men in treatment are receiving ADT.[2] Androgen deprivation therapy, usually achieved with the administration of luteinizing hormone-releasing hormone, is particularly difficult because significant, deleterious side effects occur because of the reduction of testosterone to castrate levels.

Testosterone production is regulated through negative feedback within the hypothalamic-pituitary axis. Gonadatropin-releasing hormone (GnRH) is released by the hypothalamus and stimulates the release of luteinizing hormone by the pituitary. This, in turn, stimulates the production of testosterone by the Leydig cells of the testes. The continuous exposure of luteinizing hormone-releasing hormone agents to GnRH receptors in the anterior pituitary leads to a down regulation of GnRH receptors, with an eventual decrease in luteinizing hormone and thus decreased production of testosterone.[3] Although this ensures a withdrawal of androgen support to the prostate cancer cell, the iatrogenic hypogonadal state that has been induced leads to significant and deleterious side effects.

The benefits of tumor regression and symptomatic improvement are accompanied by significant changes in physical appearance and function, affecting sexual desire, performance, and physical appearance of the reproductive organs.[4,5] Changes in physical appearance include loss of muscle mass, weight gain, increase in adiposity, and breast tenderness and enlargement.[5,6,7] Higano[7] reports loss of penile length or volume in addition to loss of testicular mass. Functional changes include hot flashes, decreased cognitive function, fatigue, and depression.[5,6,7] In addition, metabolic changes induced by ADT include osteoporosis, anemia, and a decrease in high-density lipoprotein cholesterol and may increase risk for diabetes and cardiovascular disease.[2] Although unknown at present, we might anticipate that the significant physical and functional changes will have a salient influence upon body image and, correspondingly, upon important QOL aspects.

Although the effect of treatment-induced body image changes upon QOL has been largely unexplored in prostate cancer survivors, numerous studies in women with breast cancer provide evidence for such a relationship.[8,9,10] Avis et al[8] found that body image was related to almost all QOL domains in women with breast cancer. Pruzinsky and Cash[11] emphasized the importance of the relationship between treatment-induced changes in body image and QOL, challenging healthcare providers to not only understand but also develop effective treatment programs designed to alleviate the negative consequences upon QOL.

It has been estimated that more than 50% of all men with prostate cancer will receive ADT at some point in their treatment.[12] Despite the large number of men treated with ADT and the changes induced by medical intervention on body image, there is little research focusing on how the changes in body image interact with overall QOL. This study will describe the relationship between changes in body image and QOL among prostate cancer survivors based upon whether or not treatment was with ADT.

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