Understanding "Survivorship" in prostate cancer: An investigation of predictors for "Loss of Masculinity" among RADAR participants

Abstract

Objective: Although patient self-reports are often used to describe how they react to treatment for prostate cancer, consideration of single items or report scales does not allow for an understanding of the overall and more subtle underlying themes that are present across multiple measures. Therefore, this study clarified the "Survival" process by (i) mapping the component structure of patients' self-reports of adverse symptoms; and (ii) testing those factors as predictors of patients' masculine identity. Methods: 1,070 men with locally advanced prostate cancer participating in the RADAR randomised controlled trial evaluating duration of androgen suppression and the addition of zoledronate to radiotherapy completed the EORTC QLC-C30 and PR25 scales for their degree of symptom severity on 22 items related to side eff ects of treatment for prostate cancer at intervals following initial diagnosis up to 36 months later. Principal components analysis was applied to the 22 items, and resulting factors were used in hierarchical regression and analysis of variance models to test their predictive ability for participants' Loss of Masculinity. Results: Three discrete factors emerged from the 22 self-report items, comprising: (1) Depression and Anxiety, (2) Urinary problems, and (3) Decrease in sexual interest and activity. When regressed against a single "Loss of Masculinity" target variable, Depression-Anxiety was the most powerful predictor, followed by Decrease in sexual interest and activity. Urinary problems did not significantly predict patients' masculinity status. Conclusion: D espite suggestions in the literature that urinary or sexual difficulties pose the greatest challenges to prostate cancer patients' masculinity, our results suggest that it is the symptoms of depression and anxiety which most cause these patients to lose their sense of being masculine. Evaluation of additional relevant factors is worthwhile because these fi ndings have import for those helping prostate cancer patients cope with their treatment and its side effects.