A new study from researchers at The University of Texas M. D. Anderson Cancer Center has demonstrated that men opting for radical prostatectomy may experience both long-term and short-term benefits from brief behavioral interventions through the application of stress management sessions (breathing techniques, relaxing guided imagery and cognitive therapy) prior to and immediately after surgery. The five-year long study, published in last week's issue of the Journal of Clinical Oncology, is the first to examine the benefits of psychosocial intervention for prostate cancer patients prior to surgery. “The findings from this study are of course specifically relevant to those with prostate cancer, but other studies have found benefits of pre-surgical stress management for women with breast cancer. Stress management has been found useful prior to and during a number of difficult medical procedures including breast cancer biopsy, cardiac catheterization, and renal procedures,” said Lorenzo Cohen, Ph.D. - the study's senior author and professor in M. D. Anderson's Departments of Behavioral Science and General Oncology, and director of the Integrative Medicine Program - speaking exclusively to Saudi Gazette. “We know that for men with early-stage prostate cancer, the time when they are making treatment decisions is very stressful,” said Cohen. “A radical prostatectomy is not without permanent, very personal, consequences, including the inability to get and maintain an erection and to control their urine. Both of these side effects can have a dramatic effect on men psychologically. Patients may also be worried about the uncertainty that the surgery will cure their cancer.” Prevalence Prostate cancer (a disease with an over-50 years age men), is the leading cause of cancer in men and the second leading cause of cancer death. According to the American Cancer Society, 186,320 men in 2008 were diagnosed with the disease, with it proving fatal for 28, 660 of them A review of available literature about the prevalence of prostrate cancer in the Kingdom shows that the rate of prostrate cancer in Saudi Arabia is low, as compared to Western countries. This cancer varies dramatically between being very common in black American men, to rare in Asian and Chinese men. Compared with international rates of 10-20%, the 1997-1998 national cancer registry reported carcinoma in situ to represent 2% of all of the prostate cancer cases. In 1997, King Abdul Aziz University in Jeddah calculated the average rate (collected from all relevant Saudi centers) at about 3.3%. Research method In the randomized study, 159 early stage prostate cancer, radical prostatectomy patients were assigned to receive one of two kind of treatments. Two 60-90 minute sessions of pre-surgical stress management intervention and brief booster sessions the morning of, and 48 hours following surgery or two 60-90 minute individual supportive attention sessions and boosters similar to the stress management group; or standard care. Cohen said the stress management was based on aspects of cognitive behavioral therapy, including diaphragmatic breathing and guided imagery, and it could be practiced before surgery, the morning of surgery, and post surgery. “Men were also exposed to an imaginal walk through of the day of surgery that took place prior to surgery. They imagined all the sights, sounds, sensations, smells, and feelings of the day of surgery through recovery. They also learned aspects of cognitive therapy that focused on realistic expectations, pacing, etc. This last aspect was introduced before surgery and then reinforced before they left the hospital,” he said. Aspects of mood and quality of life were measured one month before surgery, one week before surgery, the morning of surgery, and up to six weeks and six and 12 months after surgery. Relevance of research Cohen also remarked that it is known from other areas of research that going into a surgical setting overly stressed may lengthen a patient's recovery time. “With this study, we wanted to intervene in the pre- and post-surgical setting and try to help relieve stress and minimize (aspects of) mood disturbance, such as depression, anxiety and distress, both in the short- and long-term,” he added. According to him, the findings are specifically relevant to men with early stage disease as that is the segment of population observed in the study. “However, it is likely that patients at any stage of disease can benefit in some way from stress management,” he added. He does urge caution as well. “Before we can suggest that stress management is useful prior to surgery for all men undergoing a radical prostatectomy, we need to better understand the mechanism behind our findings, as well as understand for whom this type of intervention will be the most useful.” “It is probably premature to recommend stress management for all patients based on this study. However, we know from this study and others that stress management can help to improve patient quality of life. All patients should be encouraged to find some way to relieve stress.” As a follow up, Cohen said, the same study is being examined for immune-based outcomes and stress hormone levels. Asked if there were any possibilities of error in the study, Cohen said that because it was a randomized trial with a relatively large number of patients, the findings are most likely accurate and that they are also in line with the findings of research from other cancer populations. He added that the research results were ‘somewhat surprising'. “We expected to find group differences in the short term for mood disturbances, with lower levels for the stress management group, but we were somewhat surprised and pleased to find differences in physical function aspects of quality of life one year after surgery,” he said. Cohen said that if the results of his study are replicated, they may provide a useful adjunct to standard care for men with prostate cancer undergoing surgery. There are no specific early symptoms of prostrate cancer. Late stages of the disease may be represented by lower urinary tract obstructive symptoms. In rare cases the stages are represented by renal failure due to ureteral obstruction. The two well known risk factors for developing prostate cancer are aging and the presence of gonadal androgenic hormones. Other unestablished factors recently studied are: hereditary and familial factors, following a high-fat diet, smoking, vitamin D deficiency, prior vasectomy, the increased use of TURP (transurethral resection of the prostate) for BPH (Benign Prostatic Hyperplasia), the widespread use of PSA (Prostrate-Specific Antigen test) as a screening tool for prostate cancer, and having a black American genetic heritage. Unfortunately, in the Kingdom, the absence of a central cancer registry and wide-scale studies on this subject call for more education and awareness about this disease as well as the importance of screening protocols.
