A Toolkit for Dealing With the Trauma of a Prostate Cancer Diagnosis

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Title: Managing Prostate Cancer: A Guide for Living Better

Author: Andrew J. Roth, MD

Publisher: Oxford University Press

Publication date: November 2015

Price: $21.95; hardcover, 368 pages

This year, an estimated 180,890 men in the United States will be diagnosed with prostate cancer; about 21,120 men die of the disease each year. On top of these sobering statistics, from screening to diagnosis and treatment, prostate cancer is fraught with controversy, creating untoward anxiety for men and their families.

For the past 20 years, Andrew J. Roth, MD, a psychiatrist specializing in psychological support for patients with cancer, has been the liaison to the genitourinary medical oncology program at Memorial Sloan Kettering Cancer Center in New York. Dr. Roth’s new book, Managing Prostate Cancer: A Guide for Living Better, provides keen insight into how to live a meaningful life as a patient and survivor of prostate cancer.

Managing Prostate Cancer is organized in 10 chapters, covering every aspect of prostate cancer from the shockwave of diagnosis to treatment choices, intimacy issues, recurrence, and more. This is a hefty book written in smart, straightforward prose with just enough conversational tone to ease men into the hard subjects. Moreover, the book is complemented throughout with easy-to-follow charts, lists, tables, and call-out boxes. Potential authors of books in this genre should take note: Readers love these visuals.

An Anxious Visitor

In his introduction called Pregame, Dr. Roth tells of a 61-year-old businessman from the Midwest who was diagnosed with prostate cancer. His distress was compounded with bewilderment, since he had been in perfect health all his life and had no family history of the disease. That anxious visitor who traveled to Sloan Kettering planted the seed for this book.

“He said to me on our first visit, ‘For a psychiatrist, you have seen a lot of men with prostate cancer. Please paint a picture of what I need to be concerned about or what I’ll likely be facing emotionally with this cancer.’ His request alerted me to the need for a book like this for other men with prostate cancer and their families,” writes the author.

Books about prostate cancer are plentiful, but a rare few are authored by a psychiatrist on the front lines of cancer therapy, which gives Dr. Roth’s book a leg up. In chapter one, where he deals with the ‘why me’ reaction after the initial numbness goes away, he notes that after a diagnosis, men are often the last to believe they have psychological difficulties as well. Here, he describes his early intervention techniques, which involve interpersonal communication tips that readers of The ASCO Post will find useful.

Personal Experience

The author reinforces his qualifications to write a book targeting patients by relating his own medical journey after being diagnosed with an acoustic neuroma. Dr. Roth doesn’t spend too much time on himself, just enough to put a “person” behind the white coat. Also in this chapter are discussions about prostate-specific antigen (PSA) testing and biopsies, which by design, don’t go too deeply into clinical areas.

The standard cutoff for a discussion about biopsy is a PSA of 4 ng/mL, but a man can have a reading of 1 ng/mL and have cancer, whereas another man can have a PSA of 12 ng/mL and not have cancer. PSA is there to begin a patient-doctor conversation. The only way to detect cancer and its aggressiveness is by its Gleason Score after biopsy; there’s enough anxiety over PSA, we don’t need more.

Big Three Worries for Patients

Dr. Roth does a good job parsing through treatment choices, giving a balanced look at the pros and cons. Men won’t see high-intensity focused ultrasound here, as it received U.S. Food and Drug Administration approval after this book went to press. Dr. Roth also arms the reader with a series of succinctly drawn questions patients should ask their clinicians. The ASCO Post readers will find them useful, as the author is more thorough than most.

Communication is a huge part of oncology and wanting in many areas. Dr. Roth’s advice and guidance in that vital part of cancer treatment will be of value to both oncologists and caregivers.
— Ronald Piana

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This format hits a homerun when the author gets into the big three worries men have post treatment: sex, urinary, and bowel problems. Not only does he give sound advice on coping with these symptoms, he delves deep into the psychological symptoms and offers actionable advice on how to cope. For instance, most men with prostate cancer loathe when people in social situations reflexively ask how they feel. For one, it brings up internal responses men want to forget. Dr. Roth coaches them into gently moving people into a less personal socially common phrase: “How are you?

In a chapter called “Keeping the Flames of Intimacy Alive,” Dr. Roth offers a delicate touch and knowledge of this intimate part of prostate cancer, which has crushed its share of marriages. In this chapter, besides the sexual aids and coping skills, Dr. Roth offers a five-stage template for positive change, which at times is slightly wordy but packed with value.

Psychiatric Medications

Being a psychiatrist, it’s not surprising that Dr. Roth’s book begins to sail when he’s in more familiar waters. In a section dealing with issues surrounding psychiatric medications, he returns to his own medical drama, discussing his anxiety following neurosurgery. On top of anxiety, he was in pain. After some internal struggle, he writes, “I heard my own advice, ‘High anxiety and pain are not good for anyone or for your recuperation.’” This is one of the book’s strongest chapters. In thorough lay person–friendly language, it carefully discusses each medication, its clinical value, and its side effects. Included is a first-rate table, a scouting report on medications to treat depression and fatigue, and sleep issues.

Closing Chapters

The closing chapters on recurrence and late-stage disease are adept. The book’s format makes it easy for readers to pick and choose, skip chapters, and return to them. Communication is a huge part of oncology and wanting in many areas. Dr. Roth’s advice and guidance in this vital part of cancer treatment will be of value to both oncologists and caregivers. For that, and other reasons, this accomplished guidebook is highly recommended for readers of The ASCO Post. ■