From anger to the desire to live in the moment: the emotions of those facing prostate cancer.

The profile of patients with advanced prostate cancer is changing. Nearly six out of ten men with metastatic disease are proactive about their disease and want to be involved in decisions about their treatment. Broadly speaking, three distinct profiles can be identified: a "tormented" one, a "fatalistic" one (more passive), and a "resolved" one, representing those who have achieved emotional balance. A survey conducted by Elma Research for Novartis during Men's Cancer Awareness Month identifies and describes these profiles. The survey, which involved 64 Italian patients with an average age of 65 at diagnosis and a disease progression of at least five years, was presented in Milan during the event "Paths of Care for Men's Health."

The three emotional states of patients

The "tormented" patient (28% of the sample) is typically younger than average (61 years old at diagnosis) and, in most cases (83%), has had metastatic cancer from the outset. They want to play an active role in dealing with the disease they must live with, but their primary emotions are anger and a sense of injustice. Acceptance is not yet evident, but there is a profound awareness that leads them to seek change and to express great expectations of doctors and treatments. They are ready to change doctors or centers and, despite adhering to treatment, want to maintain control, seeking information about the disease and available treatments.

The "fatalistic" patient (42%) is at the opposite extreme: they are, on average, older than others (69 at diagnosis) and exhibit a passive attitude. They have accepted their illness, but tend not to confront it and do not seek change. Among the words associated with this profile is "resignation": they live with the belief that they cannot do much more and tend to delegate to doctors, with whom they develop a positive relationship of trust, and to caregivers, who are often their wife or daughter. They adhere to prescribed therapies but do not engage in the day-to-day management of their illness. Approximately half of the sample was metastatic from the start .

The third profile is that of the "resolved" patient (30%, average age at diagnosis 66). Here too, there is acceptance of the disease, but in a more positive way, leading not to passivity but rather to action. They now consider the disease an integral part of their life, after having completed a process of recovery; they demonstrate a commitment and feel responsible towards their family. They are collaborative with their doctors and are open to dialogue and sharing treatment decisions. At the same time, they are very active in seeking information and solutions that can, above all, improve their quality of life. In this case too, approximately half of the sample was metastatic from the beginning .

Work on motivation, whatever it is

"These three profiles are obviously not rigid or static, but rather they evolve," explains Simona Donegani , a psycho-oncologist at the National Cancer Institute. "Anger is the first reaction in processing trauma and is quite common. We feel unseen, misunderstood, and we feel as if someone is stealing our time. Passivity, on the other hand, is linked to a form of depression, which, however, is a necessary depression: it is the transition that allows us to truly accept the new condition. But what changes when we are able to embrace the illness is that time becomes the present: what matters is what we can experience and experience in the present. Then there is acceptance not only of the illness, but also of the limitations it entails." Hence, action, such as the decision not to lock oneself in despite incontinence. "Regardless of how the profiles are structured," Donegani continues, "all patients seeking psycho-oncological support have a motivation for doing so, and this is always positive. It's the lever we need to start working on. For example, if a delegation process is underway, the motivation could be trying to help those around them."

The treatment path must be shared

In prostate cancer, motivation is often the first casualty, emphasizes Claudio Talmelli , President of Europa Uomo Italia: "Men struggle to talk about it; they withdraw, they isolate themselves. This is why involvement is the first cure. Caregivers must also be involved: when we include them in the treatment process, fear is alleviated and hope is doubled. Therefore, making men understand that asking for help is not weakness, but courage, is our primary duty, also through sharing the stories of those who are already at a more mature stage of the journey."

When intimacy is touched

The importance of patient involvement and active participation in the treatment process is also confirmed by the results of another large European survey ( Eu-Press4 - Europa Uomo Patient Reported Shared Decision Making Study ), promoted by Europa Uomo and conducted in recent months at the Erasmus Medical Center in Rotterdam on over 600 men. "Those who feel less involved tend to report more frequent regret over the choices they've made and a worse perception of their overall well-being," Talmelli reports. The main problems are almost always related to urinary incontinence and erectile dysfunction, which is reported at all ages: a clear indication that when the sphere of intimacy is touched upon, the discussion cannot be reduced to a purely biological level.

Progress and challenges

In Italy, prostate cancer affects approximately 40,000 men each year, and 5% of these are metastatic," says Paolo Andrea Zucali , Head of the Unit for Urogenital Tract Oncology and Rare Thoracic Tumors at the Humanitas Clinical Institute. "Diagnostic and therapeutic advances in recent years, driven by the development of precision and personalized medicine, have already led to increased survival rates and improved quality of life. We must continue along this path: the most advanced forms of prostate cancer, such as castration-resistant prostate cancer, pose significant unmet needs that require ongoing research, always incorporating the voice of patients."

Clinicians and patients require a truly multidisciplinary approach, such as that of the Prostate Cancer Units, where various specialists—such as oncologists, urologists, nuclear medicine physicians, and psychologists—work together to ensure comprehensive and integrated patient care. "Where," Talmelli concludes, "the patient's perceived quality is a mandatory indicator for guiding a therapeutic and care approach based on their clinical, emotional, and relational needs."