Prostate Cancer Podcast Episode 6

Steve

Well, g'day again, Dick. Good to see you, mate. Steve, how are you, mate? We've got a special guest today.

Dick

We do. We've got someone who's decided to join us for God knows what reason. But we're very lucky and fortunate to have my partner, actually. I'm so I'm probably more fortunate than anyone. But who is a doctor? And actually a psychiatrist, hence you can see why we're probably a partnership. And she is here to add another perspective to what we're talking about with regard to prostate cancer. Her name is Dr. Marzena Rybak, speaking about Marzena in the third party. She's from Poland. And she's here to give us an opinion on what she thinks men can and can't do. And the fact she knows, and we all know, that cancer is a significant problem. It may be as many as one in six men are affected by prostate cancer. And some of Marzena's patients actually have, as she will tell you, declined to take treatment when it was necessary. And so there's a whole raft of other factors involved in this process as to why men don't want to help themselves. We've touched on the fear factor, Stephen and I, throughout these discussions. And that's one of them. But there's other reasons. It's almost like a lack of really accepting it's going to happen to them and not been afraid, just hoping that it's going to go away.

Steve

Previously, we've spoken about the other person in a man's life. And they are a significant factor. And the fact that your partner's here who also has a medical background, a human medical background, and is a psychiatrist is significant. So, Marzena, great to see you.

Dr Marzena

Thank you for inviting me.

Steve

Thanks. So I might just start off with what you've experienced in your career as a medical psychiatrist with prostate disease. And with their partners and what the impact is on them.

Dr Marzena

So I may just start by saying that I would like to kind of talk from two perspectives as a doctor and as a woman. As a doctor, I'm not an expert on prostate cancer. I'm a psychiatrist and a urologist is a better person to discuss prostate cancer with. But I did come across a number of patients who were my patients, who suffered patients who suffered from prostate cancer. Or my female patients and their partners or husbands had the illness. And I have to say that in one or two cases that I can recall from the top of my head, the partners, they were actually not my patients, refused treatment. The end was terribly tragic. And they refused the treatment because of false kind of beliefs about their manhood. I suppose that what comes down to because they were diagnosed. So they obviously went to the doctors at the initial stages. They went through the PR examinations or the perirectum examination. They went through all that. And then they declined, which they had tried to decline treatment because they worry about not being a proper man.

Dick

It's interesting you say that. And Steve, I mean, the point is that if a man and their right, thinking if I have an operation, this is possibly I may not be able to function as a man. I get an erection going forward. They have a right to be afraid of that happening. But that's counted significantly by the fact that if they don't do something, they're probably going to die.

Steve

Well, they're not going to do sex life. But they're the plain facts, Dick. What we're talking about here is the human mind and psychology. So, you know, Marzena, Dick and I have touched on embarrassment, myths, fear, anxiety. Gorillas! These are all emotions that you deal with on a daily basis. So if you had a man as a patient, a client that had prostate cancer and was refusing treatment, how would you as a psychiatrist / medico try and lead them down the path of a good outcome?

Dr Marzena

That's a very good question because in most of cases, I could convince my patients or the partners of my patients and it's a bit I often use the analogy. A lot of people, especially a lot of men, don't want to use antidepressants because they may have sexual side effects. And my counter argument is that here there is a percentage that the chance that you won't be able to have an action or have sex drive when you take antidepressants. But when you're depressed or anxious, you're not going to do it in your sex life anyway because you're just not equipped. Yes. Your brain is not interested. The same applies to prostate cancer. I think that men worry and they hear horror stories and read who knows where that after you remove the prostate, you stop being a male. And I always say, remember, you still have your testicles. A lot of men don't realize where or how big or where anatomically placed prostate is. So that's also some education really helps. And then I say to them, if you remove your prostate and do what the doctor tells you to do, you still have pretty good chance to have a happy kind of healthy sex life. If you refuse it, you may enjoy your full masculinity for a period of time. But after that, you won't be able to do anything anyway.

Steve

Yes.

Dr Marzena

And once the metastasis go to your bones and to your brain, the game is over anyway. And your penis is not going to work.

Dick

Sure.

Dr Marzena

And as I said, and I can recall one or two who, despite that, I spent a kind of long time and effort in convincing them. Those two men just refuse.

Steve

Yeah. And what was the basis of that, do you think?

Dr Marzena

The cultural background is very significant. The man feels that he's only a man when he can perform sexuality well.

Steve

Yes.

Dr Marzena

And I always kind of joke, I say that men generally overestimate the significance of big and hard penis. Women don't look at men in that way. That's the perception most men hold. But for women, that's not that important.

Dr Marzena

And even if you're that unlucky, in my opinion, even if you're that unlucky, you will lose all or most of your sexual, pre-morbid sexual function, you still can satisfy a woman in many ways.

Dick

So the woman, the winner out of all of this is the woman?

Dr Marzena

That's right.

Dick

I knew there was a catch somehow!

Dr Marzena

If you want some kind of medical weird statistics, statistically, we know, and I don't know who does those studies, but we know that only about 30%, depending on which studies you look, only about 30% of normal women are able to get vaginal orgasm. The other 70 or 80% can't. So here is the man kind of worrying about size and the stiffness of his penis. The woman doesn't care about that really in most cases. Women can be satisfied in other ways.

Steve

You touched on a really good point. And one of the early chats that Dick and I had, we talked about what is a prostate. As a medically trained person, as you are, I'm always stunned and surprised by how little people know about their own bodies. They don't even know what their liver does, for instance, and they just don't get stuff. And you'd think as a man, at least, you'd want to know what your prostate is there for. So if something goes wrong with it, well, what's the consequences of that? I think that education piece is absolutely critical.

Dr Marzena

Essential. It's essential. And just to follow on that line. So prostate is just a small gland about the size of the walnut, which is placed just under your bladder and it surrounds your urethra. So I don't know if you discussed it. We probably haven't. If I'm repeating myself just tell me.

Dick

We've touched on it from a straight definition.

Steve

Well, I couldn't touch on Dick's because he doesn't have one. But that's right.

Dick

A little bit personal!

Dr Marzena

In simple terms, the prostate fulfills two roles. One is producing the fluid to protect and support sperm.

Steve

Correct, and make semen.

Dr Marzena

And make semen. And another one is a muscular spasm, if you want, during orgasm. So it helps with ejaculation.

Steve

But it also controls urination. So early signs of prostate disease can be not able to urinate freely or frequently going or dribbling smaller amounts.

Dr Marzena

Dribbling smaller amounts at a time. That's right. Because when you think about the physical, anatomical kind of placement, it just under the bladder, so it presses on the bladder and it blocks the flow of urine.

Steve

And you can also press on the colon too. So it can be constipation.

Dr Marzena

Absolutely. Absolutely. So it is a small organ, but very significant organ. And men worry that once that little organ is removed, they won't be able to produce children or have orgasm ever. And those are kind of myths, because yes, you still can have children. You can either collect the sperm before the procedure or you still have testicles. You can remove sperm from testicles and then have in vitro fertilization of your partner. But as to the orgasm, they called dry orgasms. So the man is still able to have the orgasm. He just won't ejaculate.

Steve

It's all about you, Dick.

Dick

I just wanted to make the blokes out there who think maybe it's not going to happen again. Let me tell you.

Steve

Well, I'm going to tell you, Marzena, while you're here, let's chat about, you know, Dick and I have touched on tantric sex and kama sutra, and you know, you've already said that there's other ways that, you know, our partners can...

Dr Marzena

And there is still clitoris for those men who are watching. Remember clitoris? What is that?

Dick

That's right. They've got to know how to find it. There's a lot of men now looking out of the dictionary. Some place probably got an atlas.

Dick

Just ask your wife to direct you gently. And then listen. She will be happy.

Dr Marzena

That's right. And I think it is terribly important that the woman is involved and that the woman is a co-partner. And, you know, yes, can the relationship get broken? Of course it can, but it probably was fragile before the prostate cancer or illness. So if you love each other and if you listen and you... If the woman doesn't take it personally and doesn't think that, you know, that lack of erection or not 100% erection has something to do with her, it doesn't. And I often have those conversations with my patients about their medication. I quite often say to my male patients, I say, if your erection or lack of desire is not that great because you're an antidepressant or any other psychiatric medication, talk to your partner and tell her it's not her. It's the medication. Blame me. So it's a bit like that with the prostate cancer or prostatectomy. That it's not about the woman. A woman can show and, you know, and shine in that situation.

Steve

Sure. So if a man's greatest fear is the loss of manhood and, you know, I guess we relate that back to our sexual prowess.

Dr Marzena

That's right.

Steve

What you're really saying is sex after losing a prostate is fabulous.

Dr Marzena

It's fabulous. Can be actually much more enjoyable for a woman. Just saying it!

Steve

Even with him?

(Laughter)

Dr Marzena

It was wonderful before and really wonderful after. Yes.

Dick

You didn't know him before!

(Laughter)

Dr Marzena

This is my...

Dick

I told her!

Dr Marzena

That is my very subjective opinion. But it shows you and, you know, and it would be brave on the men because, yeah, that's true. We hadn't met before. We only met after Richard's diagnosis. And of course, it causes anxiety in any man, especially at certain age, you know, with an illness, you meet a new woman, you want to impress her. And he did by the way.

(Laughter)

Dr Marzena

But, you know, I can... Of course, I understand. And in terms of kind of therapy for men who have the surgical procedure done and they survive chemotherapy, radiotherapy, whatever they need to have, you have physio exercises, sex therapists. So the psychiatrist, I'm not an expert on the field, but it's a subspecialty of psychiatrists or sex therapists, and then pharmacological treatments. So you have a lot at your disposal to improve your performance. Yes. And then people often forget that sex really happens in our head.

Dick

Yeah, yeah.

Dr Marzena

So if you convince yourself that you can't perform or you're not going to be the same men after the operation that you were before, then you don't anyway. That's not going to work. You know, in my practice as a psychiatrist, I see a lot of especially young or middle-aged men who have difficulties with sexual performance, let's say.

Dr Marzena

And in 90% of cases, it's not anatomical or physiological illness. Mental. It's mental. Sure. Because they're anxious. Or they haven't performed once for whatever reason, they were drunk or tired or whatever, then they got it in their head that they can never perform again. And with each next attempt, they convince themselves more anxiety. And more anxiety, and they become impotent.

Dick

The situation, Marzena said that there's alternatives.

Dick

And thank God there's an alternative to Cialis with Viagra, because the Cialis gave me indigestion.

Steve

Yeah, right.

Dick

Yeah, I know. It was very downside. I thought, "Geez I can't win a trick here." But the bottom line is that there are other things and clitoral stimulation that Marzena touched on. It's really interesting that 70% of women have found something other than complain about than an erect penis. So if that's the case, then for those guys who are having their prostate out,

Dick

there's real hope here. Yeah, great. Make none mistake.

Steve

Yeah.

Dr Marzena

That's exactly right.

Steve

Well, Marzena, thank you. I mean, it's wonderful you get a psychiatrist's insight.

Dr Marzena

If I can close on my doctor mode, not my girlfriend or partner mode, many of them listening to that podcast need to remember that prostate cancer is, apart from mild skin cancers, is the most commonly diagnosed cancer in males. So that's the first thing. It's in terms of mortality, is the second most common cause of death from cancer after the lung cancer. In males. So that's worth to remember. Prostate cancer is a dangerous illness. And statistically, one in five to six men will get prostate cancer before age of 85. So keep that in mind. It may happen to anyone. So don't be foolish.

Steve

Well, I think the important qualifier there too, Marzena, is one of the few cancers that is almost completely curable.

Dr Marzena

If it's caught early.

Steve

Correct. And if it's treated. There's not a lot you can do about lung cancer or pancreatic cancer.

Dr Marzena

That's exactly right.

Steve

Prostate cancer is treatable and curable.

Dr Marzena

Curable. And you can test it or keep an eye on it just through a very simple blood test before you have to head to the doctor and have the PR examination. So just keep that in mind.

Steve

Yep.

Dr Marzena

On that note, I think.

Dick

Thank you, Marzena. That was great. Thanks. A rose among thorns!