“Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden.” – Healthyplace.com
A 2020 paper opens with the statement: “Men diagnosed with prostate cancer have a heightened risk for major depressive disorder, with rates exceeding those seen in the general male population.”[i] The authors, an Australian-Canadian multidisciplinary team, address depression resulting from blocked feelings, an issue often overlooked by those who diagnose and treat prostate cancer (PCa). Two beliefs underlie their article:
- In general, men are socialized to externalize their inner feelings by either suppressing them, or turning to things like getting angry, numbing off with alcohol or other substance use, or even risk-taking behaviors; and yet society also frowns on these, too, leaving few constructive outlets.
- Bottling up feelings—or “stuffing” them, especially anger—leads to depression.
Simply put, being diagnosed with prostate cancer (PCa), considering what to do next, choosing and going through treatment, and living with the consequences may trigger negative feelings of fear, worry, anxiety, frustration, anger, annoyance, etc. But, if it’s not okay to just “let it all hang out,” feelings go underground only to emerge as depression. Thus, the authors suggest that “…anger and emotion suppression may be implicated in pathways to, and maintenance of depression in prostate cancer.”
Prostate cancer and male depression – a vicious circle?
Depression among men correlates strongly with the traditional masculine model of the “strong, silent” type. Sadly, a large proportion of boys were shamed if they revealed emotional vulnerability, thus communicating that “soft” feelings are not okay. They grew up stunted in the ability to talk about feelings in a straightforward way. In fact, there are male-specific depression risk questionnaires that support the reality of a type of depression that results when men channel feelings of fear, anxiety, etc. into other outlets instead of dealing directly with them.[ii] So it makes sense that when powerful feelings about having PCa are stuffed, we can expect higher rates of depression.
The Australian team found this to be true. They recruited patients through a PCa help website and social media channels; those interested in participating clicked on a link to a landing page with study information where they could complete informed consent. They then completed an evaluation of emotional suppression as a mediator between anger and depressive symptoms. Of the participants who completed the enrollment and evaluation, the authors found elevated major depression symptoms reported by 49% of respondents. Simply put, nearly half of the PCa patients who participated experienced increased depression levels, with emotion suppression playing a major role. So yes, stuffing feelings during the PCa process can morph into depression.
On the other hand, a 2009 paper by a Canadian team explored the idea that not only is having cancer linked with worse depression, but depression might be linked with having worse cancer—a kind of vicious cycle. Based on the belief that psychological variables can influence cancer’s course, they “assessed the extent to which depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients.”[iii] They conducted their analysis via a search for literature on the association between depression and risk of disease progression or mortality in cancer patients.
This group discovered that depressive symptoms did not predict a worsening (progression) of the cancer, but it did predict death as the result of the cancer. In their words, depression may play a “causal role” in a poor cancer outcome. In fact, many articles and books explore the role of emotional expression plays in contributing to health benefits during injuries or disease such as cancer. While I found no studies that linked active emotional expression with better survival rates, I did find evidence that such expression generally results in fewer depressive symptoms and therefore higher quality of life.
A gender-related issue?
Returning to the Australian study of PCa and bottled-up feelings, the authors note that their findings indicate that men with PCa are at notably greater risk of depression. They suggest, “Taking a gendered lens to the assessment and treatment of mood-related symptoms of depression, including externalised or atypical presentations, may support improved outcomes in this population.” In other words, for PCa patients who are depressed, male-specific psychotherapeutic interventions might provide better emotional outcomes. Not a bad idea if, in fact, depression is a contributing factor to cancer mortality. The bottom line is, stuffing your feelings is not good for your prostate cancer.
On a brighter note, our Center’s team makes every effort to be sensitive to what our PCa patients are feeling—but I believe that right from the beginning of their PCa journey, our patients have reason to be less fearful, anxious, angry and depressed. Our MRI-guided detection and diagnosis technologies are the most accurate available, and for those who are qualified for targeted treatment using our Focal Laser Ablation, the probability of preserving their current quality of life is extremely high. In short, we are doing everything in our power to take the depression out of prostate cancer.
Download Our Free Ebook: “How to Manage Prostate Cancer Anxiety”
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NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Simon M Rice, David Kealy, John S Ogrodniczuk, Zac E Seidler, et al. The Cost of Bottling It Up: Emotion Suppression as a Mediator in the Relationship Between Anger and Depression Among Men with Prostate Cancer. Cancer Manag Res. 2020; 12: 1039–1046.
[ii] Rice SM, Ogrodniczuk JS, Kealy D, Seidler ZE et al. Validity of the Male Depression Risk Scale in a representative Canadian sample: sensitivity and specificity in identifying men with recent suicide attempt. J Ment Health. 2019 Apr;28(2):132-140.
[iii] Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009 Nov 15;115(22):5349-61.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
