Why sit ups can save a life
By Kalli Spencer
In many of our research blogs we have highlighted the psychological and beneficial effects of exercise. It has been shown that lack of strength and/or muscle power has been associated with poor survival1. During this Men’s Health Week2 (14-20 June 2021) the Prostate Cancer Foundation of Australian (PCFA) is encouraging everyone to do 45 sit-ups a day for one week (and hopefully long-term) to stay fit but to also start a conversation. But why 45? That’s because, “45 men are diagnosed each day, and over 3000 will die this year,” according to CEO of the PCFA, Professor Jeff Dunn (AO). He goes on to add that this is “currently the most prevalent cancer in Australia and by 2040, an estimated 372,000 men will be living with or beyond prostate cancer, a 60 per cent increase from around 230,000 today.”
But why do we will still have so many aggressive stages of cancer and men dying from what can be a potentially curable disease? It stems back to early detection and reluctance and delay in seeking medical advice. If one has a family history of prostate cancer particularly first-degree relatives (sons, brothers, fathers and grandfathers) they need to get themselves tested earlier than their peers who don’t have this risk. Any change in urination pattern, blood in the urine and blood in the sperm should be investigated by a general practitioner who may then make a referral to a urologist. But usually there are no signs or symptoms and a PSA at the recommended age may be a good start.
A study by Medina-Perucha et al aims to further explore the barriers for help-seeking in older men who have been diagnosed and have undertaken treatment for prostate cancer3.
The first theme observed, namely traditional male gender roles, is characterized by men’s reluctance to emotional disclosure and the need to portray themselves as strong and resilient. Men with prostate cancer present with symptoms (e.g., urinary tract-related ones) that could be attributed to non-cancer disease or to aging. Although experiencing such symptoms has an impact on men’s lives, these are not seen by some men as sensible reasons to consult their doctor.
Masculinity is not universal but a culturally embedded performance and therefore to provide good health care options we need to be able to understand some of the decision-making processes by which men perform masculinity in relation to prostate cancer and how these impacts on their ability to seek services for prostate cancer4.
Fear is the second observed theme, and is associated with distress and worry resulting from screening procedures (i.e., digital rectal examination), being diagnosed with a serious health condition (such as prostate cancer) and negative experiences with health professionals. Although only one survivor in a study by Arrington et al suffered major complications, others described their post illness lives as diminished in physical capacity5. Life after treatment is also potentially haunted by the risk of recurrence—a threat that never wholly subsides.
The third (and final theme) observed is embarrassment, closely related to the themes of traditional male roles and fear, and associated with receiving a diagnosis, medical procedures, the disclosure of symptomatology, as well as the utilization of the healthcare system. Because of prostate cancer’s effects on sexual and urinary function, narratives reflect men’s fears that the disease would emasculate them. Medical treatments often lead to erectile dysfunction, restricting patients’ sex lives, and often leading to depression. Other treatments can indirectly cause depression; hot flashes and burgeoning breasts can leave patients feeling emasculated. Incontinence often becomes a physical and emotional stressor, leaving survivors feeling powerless5.
According to psychologists Dr Kerry Ettridge from Adelaide university and Professor Suzanne Chambers from Griffith University, barriers to seeking help identified from the literature and models of behaviour include contextual (e.g. physical location, financial barriers, service availability) and individual barriers (e.g. demographic characteristics and psychological factors)6.
Men with prostate cancer may seek help from a variety of sources including informal sources of support such as social networks (friends and family) and support groups and from professional sources such as medical professionals (e.g. General Practitioner; GP) and mental health professionals (e.g. psychologists, counsellor or therapist). Whether they spoke with their personal physicians or with those who lectured at support group meetings, most survivors cited physicians as a source of information during the postdiagnosis stage5.
Stigma is complex, and conceptualisations vary; however, two main components often feature in its conceptualisation: the characteristic or attribute that makes a person “different,” and the devaluation of the person on the basis of this difference. The prostate cancer narratives provide partial support for earlier concepts related to stigma. The stories confirm the stigma that a disease label carries with it. Stigma is partially revealed in the ways prostate cancer survivors talked about themselves.
The aim of Ettridge and Chamber’s study was to conduct a qualitative investigation to provide insight into the experiences and perceptions of men with prostate cancer, with specific objectives to investigate6:
(1) how prostate cancer is perceived, including any perceived stigma associated with prostate cancer (including any attributions of self-blame, and/or isolation) and
(2) how prostate cancer affects men’s lives and relationships, and their experiences of seeking support for such issues.
Overall, there were perceptions of stigma present. These generally originated from the involvement of sexual organs, treatment side effects and challenges to masculinity, and attribution of cause and self-blame was not a prominent issue. Prostate cancer had a considerable effect on many facets of participants’ lives, and many felt social isolation, stemming from both practical and psychosocial factors.
Despite the apparent impact of prostate cancer among men in this study, including the emotional effects and social isolation felt by many, seeking support was not the norm.
Men in this study also exhibited a lack of knowledge of sources of help. There was also a perception among some men that informal support was adequate and that formal support was not required. Where informal support is concerned, partners were a main source of support for men in relationships, whereas single men generally lived alone and were more socially isolated. Furthermore, sexual dysfunction was less of a concern for those in established relationships, whereas it was a more significant source of distress for those who were single.
As regards formal support structures, one benefit of support group meetings was the opportunity to gather information directly from a group leader. Sharing stories with peers generated a sense of hope and inclusion for survivors. For many survivors, the group provided power over the illness in the form of knowledge about prostate cancer and treatment options. Seeking information from group leaders augmented survivors’ agency by giving them a task to accomplish. (5)
As urologists we speak of a trifecta or hierarchy of priorities when it comes to treating prostate cancer. Our priority is always to achieve oncological control (save a life by removing the cancer); then ensuring urinary continence where possible; followed closely by maintaining sexual function. While this is often a finely tuned balancing act, we may not always be able to succeed with all three outcomes but we certainly do strive to do our best.
So what can you do to get involved? Simply commit to doing 45 sit-ups a day, create a personal fundraising page, and show us your best sit-up by sharing photos via #situp45. Incorporate this into your daily routine whether you lying on the couch, in the park, on the beach or even at work with your colleagues. In that way you can help to turn the tide of generational reluctance to seek help, and in the process help to save the lives of the men you love – fathers, grandfathers, partners and sons who are at risk of this silent killer.
References
Ruiz JR, Sui X, Lobelo Fet al. Association between muscular strength and mortality in men: prospective cohort study. BMJ 2008; 337: 92–95.
Medina-Perucha L, Yousaf O, Hunter MS, Grunfeld EA. Barriers to medical help-seeking among older men with prostate cancer, J Psychosoc Oncol 2017; 35:5, 531-543.
Ali N, Bamidele O, Randhawa G, Hoskin P, McCaughan E. Constructions of masculinity and help-seeking for prostate Cancer. Divers Equal Health Care 2017; 14(5): 254-256.
Arrington MI. Uncertainty and Stigma in the Experiences of Prostate Cancer Survivors: A Thematic Analysis of Narrative Elements. Illn Crisis Loss 2015; 23(3) 242-60.
Ettridge KA, Bowden JA, Chambers SK, Smith DP, Murphy M BA, Evans SM, Roder D, Miller CL. “Prostate cancer is far more hidden…”: Perceptions of stigma, social isolation and help-seeking among men with prostate cancer. Cancer care. Eur J Cancer Care 2018; 27(2):e12790.
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About the Author Kalli Spencer MBBCh, FC Urol (SA), MMed (Urol), Dip.Couns (AIPC) Kalli is an internationally renowned Urological Surgeon, specialising in oncology and robotic surgery. He trained and worked in South Africa, before relocating to Australia where he has worked at Macquarie University Hospital and Westmead Hospital. His passion for what he does extends beyond the operating room, through public health advocacy, education and community awareness of men’s health, cancer and sexuality. Kalli has been involved with the Prostate Cancer Foundation of Australia for many years, advocating for improved cancer care and facilitating community prostate cancer support groups. |
