The Fear in the Middle of the Night

Christopher Lukas Health Guide
  • Some of you may have felt that my last column was insensitive. In that essay, I was suggesting that you might not have cancer that needed treatment, and so I didn’t pay attention to the very real fears that you have – whether or not you were seriously ill.
    But I do take cancer seriously. Having had it twice, I know how bad the midnight anxiety can be;
    I know that the mere word itself can send shivers through the bravest man. So let me devote a few words to those fears. Let me name some of them:
    • I’m going to die.
    • I’m going to be impotent.
    • My wife (partner) is going to leave me.
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    • I’m going to be incontinent.
    • I’m going to be in pain.
    I’ve felt all of these fears – and more. And I’ve learned how to deal with them – at least partially.
    As I suggested in last week’s essay, the first thing to do is to get a firm grip on the facts. Do you have cancer or just an elevated PSA? Is it a serious enough cancer that you need treatment? If so, what kind of treatment do you need?

    These are not simple answers, and I’ll address each in forthcoming essays, but for now, let’s assume you do have a cancer that needs treatment; let’s assume you’ve picked one of the three major current treatments – surgery, radiation or seed implantation. You’ll be worried that one or the other of the procedures you go through will leave you free of cancer, but impaired in some other way.

    How do you deal with all those fears?

    Let’s take death. The fact is, for the most part, prostate cancer grows slowly. Unless you’re under 50, and stricken with one of those rarish, virulent cancers of the prostate, it’s entirely likely that you’ll reach a ripe old age without a) feeling symptoms from the cancer or b) dying from prostate cancer. And this may be true even if you don’t get any treatment. But that won’t keep most men from fearing the cancer that’s been diagnosed.

    Pain. It’s highly unlikely that you’ll have pain. Only if your prostate cancer has spread to other organs, or to your bones, will you be likely to have pain. The relatively mild pain associated with biopsies, radiation and even surgery can easily be reduced or eliminated with aspirin, ibuprofen or the lowest rank of the stronger pain killers.

    Incontinence. Unless you choose surgery, it is highly unlikely that the other two treatments will give you any trouble with your urinary functions. Even with a prostatectomy, or surgical removal of the entire prostate, some surgeons are so clever these days that they bypass the dangers of incontinence. In fact, one friend told me that he had his surgery done at Johns Hopkins in Baltimore, and that a surgeon there had a remarkable record of not endangering urinary function with a complete prostatectomy.

    . Contemplating the loss of sexual function can be a terrible emotional burden. It may affect how you make your decision about treatment. It may make you opt for a less radical procedure than your oncologist or surgeon suggests. It might even make you think twice about any kind of treatment. Current statistics on impotence can be found on the NCI site but statistics don’t tell you whether you will be one of the 40 or 50% of men who loses some potency with radiation or surgery. And you’ll want to know what’s going to happen to you, not to some statistical mean.

  • One of the things about all of the above fears is that no one can really take them away. Fear of death, pain, impotence, incontinence – these are real fears, and they can get in the way of normal daily relationships, of your ability to work, and of enjoying life.
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    So, what do you do?

    First of all, you talk about your fears. Let’s face it, too many men don’t open up about their basic fears. They don’t discuss them with their loved ones or with their colleagues. Yet, as women know, talking about your fears can be a way to assuage them and a way to hear stories that help you deal with them.

    I recommend to everyone who has a diagnosis of any serious illness: talk to spouse or partner; talk to a psychotherapist or other emotional counselor; talk to a religious counselor, if you’re religious. Don’t hold these fears in!
Published On: June 27, 2006