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Language, masculinity, and prostate cancer therapy: a social perspective

Posted Nov 01 2010 12:00am

A recent article in the International Journal of Men’s Health argues that we need to be more honest with patients about the impact of “hormone therapy” in the treatment of prostate cancer. Unfortunately the full text of this article by Cushman et al. is not available on line, but the authors have provided a “Beyond the Abstract” commentary on the UroToday web site. (You need to register with the UroToday site to read this commentary, but access is free.)

Cushman and his colleagues make the following points:

  • The use of language by physicians and their patients may significantly affect health care outcomes.
  • The clinical effects of “hormone therapy” (i.e., androgen deprivation therapy or ADT) include medical “emasculation” through pharmacological castration, the effects of which can and do reduce the quality of life of the patients and of their partners.
  • When prescribing ADT, most urologists avoid the use of the term “castration” because of its (negative) social implications.
  • Physicians may be doing this because they believe their patients may otherwise reject ADT.
  • Patients and their partners tend to be better off when they are fully informed about how ADT works (and are given suggestions about how to manage the side effects).

It is certainly the case that words like “castration,” “impotence,” and others are “loaded” terms within Western society. It is also the case that replacing them with more politically “safe” phrases (e.g., erectile dysfunction, hormone therapy) doesn’t actually help the situation in any real way.

On the other hand, the argument that in Middle Eastern and Oriental societies the eunoch was often a man of great power and influence is not helpful to any man brought up based on modern Western traditions and value systems. It comes with a whole other set of “loaded” terminology and concepts.

It seems to The “New” Prostate Cancer Infolink that “honesty is the best policy” in dealing with any medical issue of this type. ADT is designed to lower a man’s testosterone levels. This has an almost inevitable effect on certain physical symbols of masculinity. One can choose to see this as “emasculation” or one can choose to see this as medical care for a serious clinical condition. How each individual deals with this issue is not going to be as simple as the language that is used in discussing it, because it will also depend on that patient’s self-construct of himself as an individual, developed over the prior 40 or more years. Some men and their partners will adapt to the situation with very little difficulty. For others it will be a major problem that may require all sorts of extensive help and understanding. There are certainly patients and partners for whom resolution of this change in circumstances has proven to be impossible.

While Cushman et al. seem to be very focused on the social “humiliation” associated with the language of castration and emasculation, The “New” Prostate Cancer InfoLink believes that that issue is less important than the clinical support that a patient and his partner may need as they start to understand and appreciate the implications of ADT and what can actually be done to help them in whatever ways they may need help.

We find it interesting that a vast range of ancillary medical services are available to support women who must undergo mastectomy and hormone treatment for breast cancer (starting with breast reconstruction surgery) and yet the comparable medical support for men who lose the external symbols of sexuality as a consequence of various treatments for prostate cancer are very limited.

Perhaps the real social problem here is not just the language around hormone therapy but the social need to understand and accept what real medical care implies for a man whose physical symbols of masculinity may be profoundly impacted by his treatment at almost any point along the prostate cancer treatment continuum. In our view, we have really not yet adapted to the realities of physical and emotional risk associated the modern management of prostate cancer and the consequent fears commonly expressed by the majority of men (either openly or through the inability to even talk about the topic) are all too evident every day.

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