Sexuality in the context of prostate cancer narratives

In this study we explored how men diagnosed with prostate cancer experienced their sexuality from a lifeworld perspective. One essential meaning was identified: "having the elixir of life stolen." This essential meaning had four constituents: "something that no longer exists," "the threat to manhood," "intimacy," and "staged manhood." The lifeworld for these men comprised the dynamic interaction between being deprived of their "life's elixir" and their ability to have and experience intimacy. The men were preoccupied with embodied experiences unfamiliar to them. They mourned the loss of sexuality in connection with their new life situation that threatened their identity. Their female partner was a great support, and with her the man could picture himself and at best renegotiate his sexuality. In the future, cancer care should be organized so as to enable all aspects of sexuality to be acknowledged and discussed.     

Partitioned prostate cancer prevalence estimates: an informative measure of the disease burden

STUDY OBJECTIVES: Public health burden of disease is often measured using prevalence statistics. Prevalence of invasive prostate cancer in the United States is presented according to age at diagnosis, time from diagnosis, geographical area, and two races (white and black). DESIGN: Invasive prostate cancer data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute is used for obtaining prevalence estimates. MAIN RESULTS: Despite falling prostate cancer incidence rates, the prevalence of this disease continues to rise for both white and black men. Black men diagnosed at ages 60 years and older experience lower levels of prevalence of prostate cancer than white men because of poorer survival and a smaller proportion of black men living to older ages where the disease becomes common. Black men require fewer years of follow up than white men to capture over 99% of prevalent cases (that is, 14 years versus 16 years, respectively). Prevalence estimates in the United States are traditionally based on Connecticut data. On 1 January 1997, United States prostate cancer prevalence estimates based on Connecticut are overestimated for white men and underestimated for black men. CONCLUSIONS: Partitioned prevalence estimates may provide a more meaningful and informative measure of the disease burden than conventional prevalence estimates. Prostate cancer prevalence estimates based on SEER rather than Connecticut data are better representative of the United States.     

Seeking certainty through narrative closure: men's stories of prostate cancer treatments in a state of liminality

Radical treatments of prostate cancer often lead to a pervasive liminal state that is characterised by multiple uncertainties that relate both to a possible recurrence of cancer and recovery from side effects, such as erectile and urinary dysfunctions. Liminality can make it difficult for cancer patients to narrate their experiences, as their stories lack a definite ending. After interviews with 22 Finnish men who had undergone radical prostatectomy, we analysed how men produce closure in their illness narratives. Focusing on the timelines of control visits or their anticipated recovery from side effects, these interviewees sought provisional certainty within a seemingly chaotic future. By locating erectile dysfunction in the wider context of a life‐course and interpreting their fading sexuality as a ‘natural’ consequence of ageing, these men were adjusting to their post‐operative lives. Our study further shows that the inability to adjust personal experiences to positive culturally available storylines that provide a chance for the narrative reconstruction of life, can cause materialised negative consequences, such as relationship breakdowns.     

PSA testing: Molecular technologies and men's experience of prostate cancer survivorship

Although the value of the PSA (prostate-specific antigen) test as a cancer-screening instrument remains hotly contested, over the past two decades its usage has become commonplace. While most men diagnosed with prostate cancer will die with rather than of the disease, widespread PSA screening has led to an attendant increase in cancer diagnoses and the usage of aggressive treatments to ‘combat’ it. Despite the central (if controversial) role that PSA now plays in the diagnosis of prostate cancer and monitoring for recurrence, few studies have set out to explore its role in men's experiences of the disease. Drawing on ethnographic fieldwork at a prostate cancer support group in western Canada, we seek to delineate the meanings the PSA test holds for prostate cancer survivors. For many men in the study, their PSA levels were seen to provide an objective indicator of the presence or absence of cancer, with important implications for their subjective experience of cancer diagnosis and survivorship.     

Prevalence-corrected prostate cancer incidence rates and trends.

A correction is made of prostate cancer incidence rates based on data from the Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute. Unlike conventional incidence rates reported by the Program, corrected rates remove from the population the estimated number already diagnosed with the disease. The corrected rates reflect the average prostate cancer risk for men in the at-risk population. Because of the high incidence of and relatively good survival for prostate cancer, the prevalence of this disease is high. Corrected prostate cancer incidence rates were higher in magnitude, particularly in older age groups and among Black men. For example, in 1997 for Whites, the corrected rates were 3.8 percent higher in cases aged 60-69 years, 9.3 percent higher in cases aged 70-79, and 13.1 percent higher in cases aged 80 or more. Corresponding percentages for Blacks were 5.9, 18.9, and 16.9 percent, respectively. Percent changes over calendar time were very similar between corrected and uncorrected prostate cancer incidence rates according to age and race (White and Black). Failure to account for high levels of prostate cancer prevalence in conventional incidence rates of the disease results in underestimation of the rates but little temporal difference in the trends.     

Information desired and acquired by men with prostate cancer: data from ethnic focus groups.

Information and understanding are needed so that men with prostate cancer can effectively manage and cope with their disease. Although research has shown that cultural beliefs and practices influence the way people access health-related knowledge, little research has addressed how ethnicity affects the information desired and received among low-income men with prostate cancer. This research sought to (a) describe baseline knowledge at diagnosis, information subsequently received, information sources utilized, and knowledge believed to have been helpful and (b) explore differences in desired information among men of various ethnicities. Six ethnicity specific focus groups among men diagnosed with prostate cancer were conducted. With content analysis, themes emerging from each focus group were identified and compared. Results highlight disparities in the prostate cancer information desired and acquired by men of different ethnicities.     

Lifetime occupational physical activity and prostate cancer risk

The authors compared the lifetime occupational physical activity of 452 prostate cancer cases identified through the population-based Hawaii Tumor Registry and 899 population controls interviewed from 1981 to 1983. Each job reported was classified into one of five levels of physical activity using published sources. Among men aged 70 years or older, a negative association was found between prostate cancer risk and proportion of life spent in jobs involving only sedentary or light work. Compared with men never employed in such jobs, men who spent more than 54% of their life in these jobs had an odds ratio of 0.5 (95% confidence interval 0.3-0.9). This negative association was dose-dependent, consistent across ethnic groups, and unrelated to socioeconomic status, dietary risk factors, or job-related chemical exposures. The findings for younger men were less clear, but not inconsistent with those for older men. Surprisingly, no association was found with years spent in moderately active or very active jobs in either age group. Although inconclusive, these results suggest that physical activity may be positively associated with the risk of prostate cancer, but this association is likely to be weak and indirect.     

Prediagnostic plasma vitamin C levels and the subsequent risk of prostate cancer

OBJECTIVE: Antioxidants, such as vitamin C, are hypothesized to prevent prostate carcinogenesis by protecting the DNA from oxidative damage. We assessed whether higher prediagnostic plasma concentrations of vitamin C were associated with a lower risk of prostate cancer in a well-nourished cohort of men. METHODS: Plasma concentrations of ascorbic acid (vitamin C) were previously determined in blood specimens collected between 1984 and 1990 in men participating in the Baltimore Longitudinal Study of Aging. Total plasma ascorbic acid (L-ascorbic acid plus dehydro-L-ascorbic acid) levels were measured by using a modification of the 2,4-dinitrophenylhydrazine method. Among the 498 male participants with measured plasma vitamin C levels, 62 men were subsequently diagnosed with prostate cancer during their lifetime. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals for prostate cancer. RESULTS: The median plasma concentration of vitamin C for the cohort was 1.17 mg/dL, which is in the normal to high range for older men. The age-adjusted relative risk of prostate cancer for the highest quartile (median = 1.47 mg/dL, range = 1.36-2.58) compared with the lowest quartile (median = 0.83 mg/dL, range = 0.15-0.98) of plasma vitamin C concentration was 1.31 (95% confidence interval 0.63 to 2.70, P for trend = 0.29). Adjustment for cigarette smoking status, body mass index, or plasma cholesterol concentration did not attenuate the results. CONCLUSIONS: This small but prospective study suggests that higher plasma vitamin C concentrations within the normal physiologic range are not associated with a lower risk of prostate cancer in well-nourished men.     

Role of transurethral resection of the prostate in population-based prostate cancer incidence rates.

The extensive pool of asymptomatic prostate disease in the population, which increases substantially with age, suggests that the frequent use of transurethral resection of the prostate (TURP) in recent decades has had a large effect on prostate cancer incidence. The authors identified the effect of TURP-detected prostate cancer on the observed incidence rates between 1973 and 1993 for men aged 65 years and older. They linked population-based cancer registry data from the Surveillance, Epidemiology, and End Results Program to Medicare records between 1986 and 1993 to determine whether a TURP occurred sufficiently close to the time of a prostate cancer diagnosis for them to assume that it led to the diagnosis. TURP-detected cases prior to 1986 were calculated using an indirect method that involved multiplying the TURP procedure rate in the general population (from the National Hospital Discharge Survey) by estimates of the proportion of TURPs resulting in a prostate cancer diagnosis (from Medicare data and the literature). TURP explained much of the observed increase in overall prostate cancer incidence between 1973 and 1986 and possibly all of it in men aged 70 years and older. However, its influence on the trend and overall magnitude of the rates diminished between 1987 and 1993. The changing role of TURP in detecting prostate cancer is attributed to changes in medical technology and screening practices. The declining influence of TURP on prostate cancer incidence is likely to have continued beyond the study period due to the recent introduction and increasing use of medications for treating obstructive uropathy.     

Parental age at child's birth and son's risk of prostate cancer. The Framingham Study

The authors examined the relation of parental age at birth to the risk of prostate cancer among sons with the use of data from the Framingham Study. During 42 years of follow-up (1949-1993), 141 prostate cancer cases occurred in 2,164 men. All but six cases were confirmed by histologic report. The incidence rate of prostate cancer increased from 1.70 per 1,000 person-years among sons in the lowest quartile of paternal age (<27 years), to 2.00, 2.32, and 2.74 among those of each increased paternal age category (27-<32, 32-<38, and > or =38 years), respectively. After adjustment for age and other covariates, men in the second, third, and oldest quartiles of paternal age had 1.2, 1.3, and 1.7 times increased risk of prostate cancer compared with men in the youngest quartile (p for trend = 0.049). Further adjustment for maternal age did not change the relation materially. The association of older paternal age with risk of early-onset prostate cancer (<65 years) appeared stronger than that with late-onset disease (265 years). No increased risk of prostate cancer was observed among subjects in the older maternal age category. The effect of increased paternal age on prostate cancer risk may operate through increased germ cell mutation rate or by mechanisms not yet defined.     

Serum selenium level and prostate cancer: a case-control study

Selenium is a potential chemopreventive agent against prostate cancer. This study sought to evaluate and compare the serum selenium level in men with newly diagnosed prostate cancer and noncancerous patients. Between 2005 and 2006, this prospective case-control study was performed on patients referred to Sina and Imam University hospitals, Tehran, Iran; it included 62 men with clinicopathologically confirmed diagnosis of prostate cancer (case group) and 68 men with no detectable prostate cancer [normal digital rectal examination and prostate-specific antigen (PSA) level] or any other malignant disease (control group). The serum selenium level was assessed using Zeeman graphite furnace atomic absorption spectrometer (Varian Company, Australia). The mean serum selenium level in the case and control group was 66.3 +/- 17.7 microg/l and 77.5 +/- 22.5 microg/l, respectively (P = 0.002). Serum selenium was inversely associated with prostate cancer risk. After adjustment for age, body mass index (BMI), and smoking, the odds ratio was 0.16 and 95% confidence intervals were 0.06 to 0.47 (P trendq = 0.001) comparing the highest with the lowest tertile (> or = 89.3 microg/l). No correlation was observed between serum selenium level and age, BMI, or PSA level. In conclusion, serum selenium levels in prostate cancer cases were lower than in controls, which supports the hypothesis that selenium may protect against prostate cancer.     

Gender accommodation in online cancer support groups

The postings made to Internet forums by relatives and friends of people with breast and prostate cancer are described. Women post very frequently on the prostate cancer forum and assume a communication style that is similar to women elsewhere, prioritizing emotional forms of communication over the informational forms preferred by men and showing only mild signs of accommodation to a male style. Men on the breast cancer forum are in a minority and are often responding to the current or anticipated loss of a partner. Their communication behaviour is radically different from that required by dominant conceptions of masculinity. They prioritize emotional communication and the emotional welfare of family members. They experience this new form of communication as unsettling to their conceptions of traditional masculinity. Internet cancer support groups thus favour a form and content of communication generally associated with women's culture.     

Predictors of prostate cancer screening among health fair participants

OBJECTIVES: Most previous studies of predictors for participation in prostate-specific antigen (PSA) screening for prostate cancer have been conducted in purposive samples or clinical settings. This population-based study identified factors associated with documented PSA screening among health fair participants. STUDY DESIGN: Cross-sectional survey of 2098 Nebraskan men aged 35 years and older who participated in a health fair in central and eastern Nebraska in 1993. METHODS: All participants were offered a PSA screening and a questionnaire to collect information on demographics, family medical history, lifestyle factors and self-perceived health status. Predictors of PSA screening were estimated by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Men were more likely to accept the PSA screening if they were older than 50 years of age (OR=3.1; 2.4-3.9), had a higher income (OR=1.5; 1.1-2.1), were currently employed (OR=1.4; 1.0-2.5), perceived their health status as good (OR=1.1; 0.8-1.5) or excellent (OR=1.4; 1.0-2.1), and believed that they themselves, rather than physicians, should be responsible for their health (OR=1.3; 1.0-1.7). Compared with men aged 50-59 years, the ORs of participation were 0.8 (0.6-1.1) for age 60-69 years and 0.7 (0.5-1.1) for age 70+ years. Decision making was not related to education, marital status or body mass index. Predictors of screening remained unchanged when analysis was limited to men aged 50 years and over, whereas only high income and non-smoking status predicted participation among men younger than 50 years of age. CONCLUSIONS: Age, income, employment status, perceived control of health and perceived heath status were related to participation in PSA screening for prostate cancer, particularly in men older than 50 years of age. Willingness to receive a PSA screening among men aged 50 years and over decreased with increasing age.     

Lifetime and recent prostate specific antigen (PSA) screening of men for prostate cancer in Canada

BACKGROUND: In spite of national guidelines which do not recommend prostate specific antigen (PSA) screening for prostate cancer or are inconclusive, Canadian men may be accessing the screening test. METHODS: For the purpose of informing prostate screening policy, cross-sectional self-reported data from the Canadian Community Health Survey (2000-2001) were analyzed to determine the lifetime and recent PSA screening prevalence of Canadian men aged 50 and older with no prostate cancer, and to explore the socio-demographic characteristics associated with ever being screened. Multivariate binomial regression analyses were used to calculate prevalence rate ratios as a measure of association between respondents' characteristics and PSA screening behaviour. RESULTS: Almost half of Canadian men over the age of 50 years (47.5%; 95% CI=46.4-48.5) reported receiving PSA screening during their lifetime. Seventy-two percent (71.8%) of PSA screening was performed within one year prior to the survey or recently. Lifetime prevalence was highest among men aged 60-69 (53.1%; 95% CI=51.1-55.1). Next to advanced age, having a family doctor was the most predictive of screening behaviour (PRR=1.83, p<0.01). Black ethnicity, a risk factor for prostate cancer, failed to be predictive of screening (PRR=1.04, NS). Not speaking French or English was strongly associated with not obtaining a PSA screen (PRR=0.66, p< or =0.01). INTERPRETATION: Our finding that Canadian men commonly reported PSA screening for prostate cancer is not congruent with national guidelines. While we wait for randomized controlled trial evidence of the effectiveness of PSA screening in reducing mortality due to prostate cancer, PSA screening has emerged as a public health issue.     

Men's experiences of sexuality after cancer: a material discursive intra-psychic approach

Men can experience significant changes to their sexuality following the onset of cancer. However, research on men's sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on men's sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, men's intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of ‘normal’ masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Men's relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.     

Adjusted odds ratios under nondifferential misclassification: application to prostate cancer

The high prevalence of unsuspected prostate cancer among middle-aged and elderly men is unique among cancers. With their uncertain natural history, unsuspected prostate cancer cases may be misclassified into control groups in which they can obscure the identification of prostate cancer risk factors in case-control studies. Assuming that the exposure experience of diagnosed and of unsuspected prostate cancers is the same (nondifferential misclassification), case-control odds ratios are biased toward the null, which may provide a rationale for reexamining findings in negative case-control studies of prostate cancer. This article reviews the evidence supporting a high prevalence of prostate cancer and describes formulae that can be used to adjust for misclassification bias in completed case-control studies and to estimate required sample sizes in proposed studies.     

A case-cohort study on prostate cancer risk in relation to family history of prostate cancer

We investigated the risk of prostate cancer in relation to a family history of prostate cancer in 58,279 men ages 55-69 years. We found 704 incident cases after 6.3 years of follow-up. Rate ratios and 95% confidence intervals for having an affected vs nonaffected father and brother were, respectively 1.44 (0.80-2.58) and 5.57 (1.61-19.26). We found no evidence for an increasing risk with an increasing percentage of affected family members. The associations we observed were stronger for cases diagnosed before age 70 compared with cases diagnosed after age 70 and for advanced compared with localized tumors.