For patients with prostate cancer, dysfunction due to treatment side effects results in increased emotional distress – and vice versa

New study in The Journal of Urology® recommends greater investment in psychosocial care to reduce further loss of urinary, sexual, and bowel function in prostate cancer survivors

New York, May 31, 2018

A new study published in The Journal of Urology® reports that men with prostate cancer who had worse urinary, bowel, and sexual function after surgery or radiotherapy than others experienced more emotional distress. Interestingly, the reverse was also true as experiencing more distress led to worse function. The likelihood of this reciprocal relationship highlights the importance of greater investment in psychosocial care to mitigate treatment side effects in prostate cancer survivors.

Patients with cancer frequently experience emotional distress, not only when they are diagnosed and during treatment, but also into long-term survivorship. Studies have shown that interventions to reduce the emotional burden of disease in patients with cancer can promote recovery and reduce associated costs.

Most of the 2.8 million survivors of prostate cancer in the United States have been treated with definitive therapy, typically surgery and/or radiotherapy, and have a favorable prognosis. Men treated surgically often experience some degree of urinary incontinence, especially in the first year following treatment, and most experience erectile dysfunction even two years after surgery. While emotional distress decreases in most prostate cancer survivors, some have high emotional distress that does not decline over time to a level consistent with the general population.

“There is growing appreciation for the need to support cancer survivors’ emotional well-being during survivorship, and for prostate cancer patients a key concern is mitigating the influence of treatment side effects on quality of life, including psychological well-being,” explained Heather Orom, PhD, Associate Professor, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA, and co-investigators.

In the current study the authors investigated whether urinary, sexual, and bowel dysfunction contributes to emotional distress during the first two years after treatment, and whether distress may in turn further decrease function. They assessed more than 1,100 men diagnosed with clinically localized prostate cancer who were treated with surgery (63 percent) or radiotherapy (37 percent). Urinary, sexual, and bowel function was assessed using the Expanded Prostate Cancer Index Composite and emotional distress was assessed using the National Comprehensive Cancer Network® Distress Thermometer. Patients were evaluated before treatment and six weeks thereafter, with follow-up at six, 12, 18, and 24 months. The investigators analyzed how function at one time point influenced distress at a subsequent time point and vice versa, taking into account differences in men’s pretreatment function and distress.

Results highlight the likelihood of a reciprocal relationship between treatment side effects and emotional distress. Because the researchers followed the men over time, they were able to establish strong evidence of a causal relationship between urinary, sexual, and bowel function after definitive treatment and emotional distress. While men on active surveillance were not included in the analyses, the bidirectional relationship between function and distress applied to this group as well.

“These findings indicate that in addition to meeting an important need among some survivors, providing psychosocial support may help mitigate side effects,” explained Dr. Orom and colleagues. “It is not simply adequate to monitor patients with cancer for distress and physical quality of life issues. Intervention must be accessible.”

“As urologists, we want men who are treated for prostate cancer to return to their way of life. In order to do so, we must determine better ways to assist men through their emotional distress. Curing their cancer is only the beginning to making them whole,” said co-author Willie Underwood III, MD, Associate Professor of Urologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

The investigators propose two health policy changes that could improve survivor well-being: increased access to healthcare coverage for treatments of erectile dysfunction and better access to psycho-oncologic care at diagnosis and after treatment in men who experience a high level of distress. “Given the likely bidirectional nature of the relationship between side effects and emotional distress, it makes sense for facilities that have traditionally not incorporated psychosocial care into practice to consider doing so,” they advise.


Notes for editors
The article is “Worse Urinary, Sexual and Bowel Function Cause Emotional Distress and Vice Versa in Men treated for Prostate Cancer,” by Heather Orom, Caitlin Biddle, Willie Underwood III, and Christian J. Nelson ( It appears in The Journal of Urology®, volume 199, issue 6 (June 2018) published by Elsevier.

Full text of this article is available to credentialed journals upon request; contact Eileen Leahy at +1 732 238 3628 or to obtain copies. Journalists wishing to interview the authors should contact Heather Orom at +1 313 618 6496 or

This study was supported by National Cancer Institute Grant R01#CA152425.

About The Journal of Urology®
Established in 1917, The Journal of Urology® is the official journal of the American Urological Association. It is the most widely read and highly cited journal in the field. It brings to its readership all the clinically relevant information needed to stay at the forefront of this dynamic field. This top-ranking journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide and practice-oriented reports on interesting clinical observations.

About the American Urological Association
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology and has more than 22,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.

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Media contact
Eileen Leahy
+1 732 238 3628