Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

Abstract

Purpose Body image, self-esteem, and masculinity are three interconnected constructs in men with prostate cancer, with profound effects on quality of life. This meta-synthesis aimed to evaluate all known qualitative studies published studying the effect of prostate cancer on these constructs. Methods A systematic review utilising PubMed, Embase, MEDLINE, and PsycINFO databases up to May 2020 was conducted in line with PRISMA and ENTREQ guidelines. All qualitative studies of men’s experiences with body image, self-esteem, and masculinity whilst living with prostate cancer were included. A thematic meta-synthesis was conducted to identify emergent descriptive and analytical themes under the main study constructs. Results Of 2188 articles identified, 68 were included. Eight descriptive themes were identified under two analytical themes: ‘Becoming a Prostate Cancer Patient’ and ‘Becoming a Prostate Cancer Survivor’. These described the distress caused by changes to body image, sexual functioning, sense of masculinity, and self-esteem, and the subsequent discourses men engaged with to cope with and manage their disease. A key element was increased flexibility in masculinity definitions, and finding other ways to re-affirm masculinity. Conclusions Prostate cancer has an important effect on men’s health post-diagnosis, and we identified strong relationships between each construct evaluated. The role of hegemonic masculinity is important when considering men’s coping mechanisms and is also a key factor when addressing these constructs in counselling post-treatment. Implications for Cancer Survivors This meta-synthesis provides key topics that uniquely affect prostate cancer survivors, enabling these patients to be effectively counselled, and have their concerns recognised by clinicians.

Prostate Cancer Eligible for Radical Prostatectomy: Self-Esteem of Patients and Forms of Coping with Stress

“…Most of these negative effects are strongly associated with chronic stress, which often accompanies diagnosis and treatment and also aggravates negative immune changes, thus promoting tumorigenesis and metastasis and reducing the effectiveness of anti-tumor therapies [ 10 ]. Furthermore, prostate cancer and radical prostatectomy significantly change the self-esteem, body image, and sense of masculinity in men with a diagnosis [ 11 ]. Besides being told they are seriously ill, men are faced with the fact that having a prostate removed can have a significant impact on their sex life, and the possible loss of sexual function is also difficult for them to discuss with doctors or even other men [ 11 ].…”

“…Furthermore, prostate cancer and radical prostatectomy significantly change the self-esteem, body image, and sense of masculinity in men with a diagnosis [ 11 ]. Besides being told they are seriously ill, men are faced with the fact that having a prostate removed can have a significant impact on their sex life, and the possible loss of sexual function is also difficult for them to discuss with doctors or even other men [ 11 ]. This often results in withdrawal from or a significant limitation of contacts and strongly influences their social life and often their families’ lives.…”

The Psychosocial Consequences of Prostate Cancer Treatments on Body Image, Sexuality, and Relationships

“…Incontinence can be humiliating and can decrease men's quality of life (Stewart et al, 2003;Powel and Clark, 2005;Downing et al, 2019); as can management strategies that include the use of pads and other absorbent undergarments (Palmer et al, 2003). These lifestyle changes may in turn lower patients' self-confidence and make them withdraw socially (Bowie et al, 2021).…”

The impact of radical prostatectomy on the social well‐being of prostate cancer survivors: A qualitative meta‐synthesis

“…Radical prostatectomy offers one curative treatment modality for clinically significant localised cancer but can be associated with significant postoperative sequelae (Sanda et al, 2018). Physical implications such as erectile dysfunction, loss of libido and urinary incontinence are common (Emanu et al, 2016; Hoyland et al, 2014) and can have a profound subsequent impact on men's mental health, body image and overall well‐being (Bowie et al, 2021; Brunckhorst et al, 2020). Furthermore, there is now an increasing acknowledgement that radical prostatectomy can have a negative implication on the patient's social relationships and interactions with others, such as intimate partners, family and friends (Collaço et al, 2018).…”

“…libido and urinary incontinence are common (Emanu et al, 2016;Hoyland et al, 2014) and can have a profound subsequent impact on men's mental health, body image and overall well-being (Bowie et al, 2021;Brunckhorst et al, 2020). Furthermore, there is now an increasing acknowledgement that radical prostatectomy can have a negative implication on the patient's social relationships and interactions with others, such as intimate partners, family and friends (Collaço et al, 2018).…”