Abstract
PurposeBody 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.MethodsA 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.ResultsOf 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.ConclusionsProstate 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 SurvivorsThis 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.
Highlights
Prostate cancer (PCa) is the second most frequent cancer in men worldwide [1], with an often long and indolent course
The concept of masculinity focussed on by this review was the social concept of gender, which is influenced by historical, social, and cultural factors [21], and reflects the differing view men may have about masculinity and how they embody this, or how it has been affected by a diagnosis of PCa
Of the 68 studies, 36 addressed issues related to body image [11, 30–64], 68 masculinity [11, 30–96], and 50 selfesteem [11, 30–50, 52, 53, 55–59, 61, 62, 64, 66, 68–70, 72, 73, 78, 79, 81, 84, 86, 88–92, 94, 96], with most studies containing data relating to multiple themes
Summary
Prostate cancer (PCa) is the second most frequent cancer in men worldwide [1], with an often long and indolent course. Treatment side effects and the impact of the diagnosis itself may underlie the high prevalence of depressive and anxiety symptoms in men with PCa before, during, and after treatment [3]. Up to 60% of men experience mental distress during the course of their diagnosis or treatment [4], highlighting that the majority will experience effects on their mental wellbeing. The reasons for this are complex, with anxiety related to treatment decisions [5], distress related to PSA testing [6], and the impact of a cancer diagnosis [7] all likely contributing factors. Body image [8], self-esteem [9], and sense of masculinity [10, 11] are all impacted by a diagnosis of PCa, and are often impacted together: for example, body image and masculinity
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