The impact of Androgen Deprivation Therapy on men diagnosed with prostate cancer : a mixed-method analysis of body image, masculine identities, exercise habits and coping strategies

• Main Author: Gentili, Caterina
• Format: Dissertation
• Language: English
• Published: University of the West of England 2021
• Subjects: ADT; Body Image; Coping Strategies; Exercise; Masculinity; Prostate Cancer

Androgen Deprivation Therapy is one of the gold standard treatments for Prostate Cancer (PCa). By suppressing testosterone production, ADT slows down cancer growth, but can also lead to several side effects affecting bodily functions and appearance (e.g., weight gain, breast enlargement, fatigue, hot flushes, incontinence, erectile dysfunction). Such side effects may impact patients' body image and masculine self-esteem, but research in this area is still limited. Exercise may help counterbalance ADT side effects and enhance PCa patients' wellbeing, improving body image and masculine self-esteem outcomes too. However, adherence to exercise recommendations is low among PCa patients. This PhD used a mixed methods approach to explore PCa patients' experiences with ADT, its impact on body image and masculine self-esteem, the potentially protective role of exercise and other coping strategies, as well as exercise barriers. Study 1 was based on 22 semi-structured interviews with PCa patients receiving ADT, who expressed appearance dissatisfaction focusing on body feminization. Participants exercised to counterbalance ADT side-effects and re-establish a sense of control and achievement. However, some men described being worried that their appearance and physical performance would be judged by others in public exercise settings. Study 2 tested these themes quantitatively by comparing a group of PCa patients undergoing ADT (n = 60) to PCa patients who never received ADT (ADT-naïve) (n = 60), and a group of men who never received a PCa diagnosis (cancer-free) (n = 60) on body image and masculine self-esteem related outcomes. The cross-sectional study also tested several theoretical models on the association of high exercise frequency with low body image and masculine self-esteem concerns as well as the role of fear of negative appearance and physical performance evaluation as a potential exercise barrier. The results from Study 2 were mixed: while ADT was associated with masculine self-esteem issues, the three groups did not significantly differ in their levels of body image issues and exercise frequency was not a significant predictor of any of the outcome variables. The mismatch between the results of Study 1 and Study 2 informed the design of Study 3, a mixed methods exploratory study investigating different coping strategies applied by PCa patients (n = 97) to deal with ADT side effects and their association with body image and masculine self-esteem issues. The study found that acceptance was the most frequently reported coping strategy and that it was associated with positive body image and masculine self-esteem outcomes. Overall, the study found that the most frequently used coping strategies (i.e., Acceptance and Active Coping) were also associated with positive body image and masculine self-esteem outcomes, while the least frequently used strategies (i.e., Self-Blame, Disengagement, Substance Use, Denial) were associated with negative outcomes. In conclusion, while ADT seems to affect some PCa patients' body image and masculine self-esteem, the results of this PhD also suggest that many men manage treatment side effects well and engage in strategies that are effective when coping with the impact of such bodily changes. Various forms of exercise seemed to support some PCa patients to deal with the physical and psychological impact of ADT. However, more research is needed to fully understand the effect that different forms of exercise and different motivations to engage in exercise might have on PCa patients' wellbeing.