In a recent episode of the Oncology-on-the-Go podcast in collaboration with the American Psychosocial Oncology Society (APOS), host Daniel C. McFarland, DO, was joined by Christian J. Nelson, PhD, to discuss the often-overlooked subject of sexual health issues for men after cancer treatment. The discussion emphasized the importance of a nuanced approach to men's health, particularly in the context of genitourinary cancers like prostate and testicular cancer.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY®. He opened the conversation by highlighting that while cancer’s physical effects are well-documented, the mental and emotional toll is equally significant and often underappreciated in male patients. He highlighted that the field of psycho-oncology, which began with breast cancer, is now expanding to address men’s specific needs. Men, he noted, are less likely to seek mental health support, yet have a higher risk of suicide, particularly at key moments in their cancer journey like diagnosis and recurrence.

Nelson, chief of Psychiatry Service, attending psychologist, and codirector of the Psycho-Oncology of Care and Aging Program at Memorial Sloan Kettering Cancer Center, underscored that cancer treatments, especially for prostate cancer, often have profound adverse effects (AEs) that impact a man’s sense of self and masculinity. 

He detailed the effects of radical pelvic treatments and androgen deprivation therapy (ADT), which can lead to urinary incontinence, erectile dysfunction, and changes in sexual function and body image. These AEs can lead to feelings of being "broken," "inadequate," or "deflated."

The pair discussed the "double-edged sword" of normalizing cancer, where patients are told their prognosis is good but are left unprepared for the life-altering AEs. This can lead to a sense of cognitive dissonance and isolation. The conversation stressed the need for clinicians to proactively normalize discussions about sexual health, making it clear that these are standard and expected aspects of the cancer experience.

Both clinicians suggested that establishing a trusting relationship with patients is paramount and that referrals to psycho-oncology should be framed as an essential, not optional, component of treatment. They also recommend that clinicians consistently check in with their male patients about emotional and sexual well-being, even long after treatment has ended, to ensure they’re coping with the lasting impacts of their experience.