Prostate cancer is the most common non-skin cancer in men. It is fraught with both physical and psychological symptomatology. Depression, anxiety, stress, fatigue, pain and psychosocial factors all affect the patient with prostate cancer. Impotence, erectile dysfunction, sexual issues and incontinence in these patients complicate matters further. Anxiety may exist both before testing and while awaiting test results. Confusion over choosing from various interventions often adds to anxiety and depression in these patients. Various demographic factors and the developmental stage of the couple affect these psychological symptoms. The caregiver may undergo significant psychological turmoil while caring for a patient diagnosed with prostate cancer, which is addressed. The role of nurses in the management of prostate cancer is discussed. The present review looks at psychological issues in patients with prostate cancer from a clinical perspective, with the aim of highlighting these issues for the clinical urologist dealing with these patients. It also explores the consultation --liaison relationship between psychiatrists, psychologists and urologists as a team for the multimodal management of prostate cancer.
Objectives: Male osteoporosis /MOP/ is increasingly recognized as a significant public health concern with serious economic burden. The objective of this study is to provide an analysis of recent findings in MOP screening and evidence of treatment in Bulgaria. MethOds: 6743 free of charge dual-energy X-ray absorptiometry (DXA) measured at the lumbar spine or femoral neck at a single medical center during the period 21.03.2106 -21.12.2017 were reviewed to calculate the rate of DXAs done in men > 65y. Patients with BMD T-score -2.5 or lower were asked to provide medical records. Results: Only 216 DXAs or 3.2% were done in men> 65y. Neither of them was referred by a healthcare professional. 16 /7.4%/ had BMD T-score -2.5 or lower, average -3.4 /range -2.5 to -4.8/, 6 had documented fracture/s, 2 had history of malignancy. Only 4 patients were on medication -Vit D and irregular use of bisphosphonates. All rated the cost of DXA and co-payment for biologic medication as most common problem related to access and affordability of treatment. cOnclusiOns: MOP remains largely underdiagnosed and undertreated in Bulgaria -a country where 17.2% from the male population is > 65 y. /2016/ and far less received the degree of awareness as with women. Co-payment for innovative therapy /50%/, complicated prescription procedures and lack of reimbursement for DXA are considered as hurdle to diagnosis and treatment access.
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