Prostate Cancer Patients Confronting Mortality:

 How Men with Prostate Cancer Face Mortality

BLUF (Bottom Line Up Front): Men with prostate cancer face unique psychological challenges when confronting mortality, often complicated by masculine norms that discourage emotional expression and help-seeking. Research shows that death anxiety affects 25-45% of prostate cancer patients, varying by disease stage and treatment status. Evidence-based interventions—including male-focused support groups like IPCSG, Meaning-Centered Psychotherapy adapted for men, and engagement with artistic explorations of mortality such as films "The Seventh Seal" and "All That Jazz"—can significantly reduce existential distress. Men who openly address mortality concerns through peer support, legacy work, and professional counseling report better psychological outcomes and quality of life than those who suppress these fears.

The Unique Challenge for Men with Prostate Cancer

When you're diagnosed with prostate cancer, you join approximately 300,000 American men who receive this news each year. But beyond the medical protocols and treatment decisions lies a deeper challenge that many men struggle to discuss: the confrontation with your own mortality.

Research shows that men with prostate cancer face distinctive psychological hurdles. A 2023 study in Psycho-Oncology found that men are significantly less likely than women to seek psychological support for cancer-related distress, despite experiencing comparable—and sometimes higher—levels of death anxiety. Traditional masculine norms about stoicism, self-reliance, and emotional control can make it harder for men to acknowledge and address existential fears.

Dr. Christian Nelson, a psychologist at Memorial Sloan Kettering Cancer Center who specializes in prostate cancer patients, notes that "men often experience their cancer diagnosis as a threat not just to life but to identity—to their sense of masculinity, control, and competence." This dual threat can intensify existential distress while simultaneously making it harder to seek help.

What Makes Prostate Cancer Different

Several factors make the mortality awareness associated with prostate cancer particularly complex:

The "Watch and Wait" Paradox: Many men with low-risk disease choose active surveillance, creating what researchers call "living with the enemy." A 2024 study in European Urology found that men on active surveillance experience persistent death anxiety even when their disease remains stable. You're aware you have cancer, but you're not actively treating it—a situation that can heighten existential uncertainty.

Treatment Side Effects and Masculinity: The potential impacts on sexual function and urinary control strike at core aspects of masculine identity. Research published in BJU International shows that concerns about these effects often become intertwined with mortality fears, creating what psychologists term "compounded existential distress."

The Numbers Game: Unlike many cancers, prostate cancer often comes with competing statistics about survival—some men live decades with the disease, while others face aggressive progression. This ambiguity can paradoxically increase anxiety. As one IPCSG member put it, "I didn't know if I had years or months, and nobody could tell me for certain."

Age and Life Stage: Many men are diagnosed in their 60s or 70s, already contemplating retirement and legacy. The cancer diagnosis can accelerate and intensify these natural end-of-life considerations. Younger men diagnosed in their 40s and 50s face different challenges—the disease feels "out of time" and threatens plans they assumed they'd have decades to fulfill.

The Research on Men and Death Anxiety

Recent studies have illuminated how prostate cancer patients specifically experience and can address mortality concerns:

Prevalence and Patterns: A 2023 systematic review in Supportive Care in Cancer analyzing 27 studies found that death anxiety affects 25-45% of prostate cancer patients, with highest rates among men with metastatic disease (35-55%), those experiencing biochemical recurrence after treatment (30-40%), and paradoxically, some men on active surveillance (20-35%).

Gender-Specific Barriers: Research from the University of Toronto published in Journal of Psychosocial Oncology (2024) identified specific barriers men face: reluctance to appear vulnerable, viewing help-seeking as weakness, preference for "doing" over "talking," and lack of male role models openly discussing death fears.

What Works for Men: The same research identified effective approaches tailored to men's preferences: peer support from other men with prostate cancer (highly effective), structured problem-solving approaches (more acceptable than open-ended emotional processing), legacy projects and "productive" activities (creating meaning through action), and male-friendly therapy formats that emphasize practical tools over emotional exploration.

The Support Group Advantage: A 2023 study comparing different support modalities found that men in prostate cancer-specific groups (like IPCSG) showed greater reduction in death anxiety than those in mixed-gender cancer groups or general counseling. The researchers attributed this to the normalization effect—seeing other men openly discuss mortality made it feel more acceptable and "masculine."

Cinema as a Path to Understanding

Two landmark films offer profound explorations of mortality that resonate particularly with men facing life-threatening illness:

"The Seventh Seal" (1957): Ingmar Bergman's masterpiece follows Antonius Block, a medieval knight returning from the Crusades during the Black Plague, who encounters Death personified and challenges him to a chess match. If Block wins, Death must spare him; if he loses, Death claims him.

What makes this film powerful for men with prostate cancer is that Block doesn't spend his time trying to win the game—he knows that's ultimately impossible. Instead, he uses the time the game buys him to seek meaning and perform meaningful acts. He questions a priest about God's silence, protects innocent people from fanatics, and ultimately sacrifices himself to save a young family.

The knight's journey mirrors what many prostate cancer patients experience: the diagnosis is the moment Death sits down across from you. You can't ultimately win that game—none of us can—but you get to decide what you do with the time the "match" provides. Do you spend it in denial and fear, or do you, like Block, use it to clarify what matters and act accordingly?

Bergman created the film while grappling with his own existential fears, and his protagonist embodies a particularly masculine response to mortality—not through bravado or denial, but through action, protection of others, and the search for meaning through deeds rather than words.

"All That Jazz" (1979): Bob Fosse's semi-autobiographical film presents a more modern meditation on death through Joe Gideon, a workaholic choreographer and director facing heart disease. Gideon quite literally negotiates with Death, personified as a beautiful woman named Angelique who appears to him in visions.

What resonates for many men with prostate cancer is Gideon's struggle with control and legacy. He's spent his life controlling every detail of his performances, but he cannot control his failing body. He's alienated loved ones through his obsessive work, and now faces the question: what has it all been for?

The film's famous ending—where Gideon stages his own death as a spectacular musical number, "Bye Bye Life"—represents a uniquely masculine attempt to assert control even in dying. Fosse, who made this film after his own heart attack, was exploring how men face mortality when their identity has been built on productivity, control, and achievement.

Many prostate cancer patients identify with this tension. You've built a life, a career, a family—you've been the provider, the problem-solver, the man in control. Cancer strips away that control and forces you to confront limitations. Gideon's journey suggests that acceptance doesn't mean passivity; it means choosing what you can control (how you spend your time, how you treat others, what you leave behind) while acknowledging what you cannot.

Both films offer a crucial insight: confronting mortality doesn't make you weak—it makes you honest. And that honesty, paradoxically, can free you to live more fully with whatever time remains.

Professional Help Available Locally

For IPCSG members and other prostate cancer patients in San Diego, UC San Diego Health's Moores Cancer Center offers comprehensive psycho-oncology services specifically designed to address the psychological challenges of cancer, including death anxiety and existential distress.

Specialized Counseling and Therapy Services: Moores Cancer Center maintains a dedicated team of psychiatrists and psychologists who specialize in oncology. These providers have expertise in addressing the emotional and psychological needs specific to cancer patients and their families, including depression, anxiety, insomnia, stress, grief, and existential concerns that either stem from the cancer experience or interfere with cancer treatment.

The team uses evidence-based psychotherapy treatments—including approaches like Meaning-Centered Psychotherapy that have proven effective for reducing death anxiety in cancer patients. Services include individual counseling, couples therapy, and family counseling, all focused on problem-solving and improving quality of life during cancer treatment.

How to Access Services: Moores Cancer Center patients can access these services through referral from their oncologist or palliative care provider. To schedule an appointment, contact the Counseling and Therapy Services directly at 858-249-2770. The team can work with most insurance carriers, including those with separate mental health benefits, to ensure coverage for these specialized services.

Additional Support Resources: Beyond individual therapy, Moores Cancer Center offers support groups, a Patient and Family Resource Center with educational materials and comfort items (858-822-6152), and social work services to address practical, emotional, and social challenges. These services are often free for patients receiving cancer care at UC San Diego Health.

As the only National Cancer Institute-designated Comprehensive Cancer Center in San Diego County, Moores Cancer Center integrates psychological support with cutting-edge medical care, recognizing that addressing the emotional and existential challenges of cancer is essential to comprehensive cancer treatment.

Practical Strategies That Help Men

Based on current research and clinical experience with prostate cancer patients, here are approaches that men have found beneficial:

Connect with Other Men: The IPCSG and similar prostate cancer-specific groups provide something crucial—other men who understand. Research consistently shows this is one of the most effective interventions for reducing death anxiety in male cancer patients. When you hear another man—perhaps someone who reminds you of yourself—openly discuss his fears about mortality, it gives you permission to acknowledge your own.

Reframe "Talking" as Strategic Planning: If traditional therapy feels uncomfortable, consider it analogous to consulting an expert when facing a complex problem. You wouldn't hesitate to consult a financial advisor about retirement planning—think of a psychologist specializing in oncology as a consultant helping you plan for one of life's most important transitions.

Create Something That Lasts: Men often find meaning through building, creating, or leaving something behind. This might be:

• Writing your life story or lessons learned for children and grandchildren
• Recording video messages for future milestones (graduations, weddings)
• Organizing family history and photographs
• Contributing to causes that matter to you
• Mentoring younger men in your profession or community
• Documenting knowledge or skills that might otherwise be lost

A 2024 study in Death Studies found that legacy projects significantly reduced existential distress in men with advanced prostate cancer while also benefiting their families.

Action-Oriented Approaches: Men often respond better to therapies that emphasize doing rather than just feeling. Meaning-Centered Psychotherapy, adapted for prostate cancer patients, uses structured exercises to identify values and take concrete actions aligned with those values. This feels less like "therapy" and more like mission planning—which many men find more acceptable.

Physical Expression: For some men, physical activities—whether exercise, woodworking, or other hands-on projects—provide a way to process difficult emotions. Research shows that men often use physical activity as a form of emotional regulation, and this can be adaptive as long as it's not the only coping mechanism.

Educate Yourself: Many men feel more in control when they deeply understand their disease. This knowledge-seeking can be healthy—it's only problematic if it becomes obsessive or replaces other forms of coping. Understanding the technical aspects of your cancer might help you feel less helpless.

Gradual Opening Up: You don't have to transform overnight into someone who openly discusses feelings. Start small—perhaps share one concern with your partner or mention one fear in your support group. Research shows that even modest increases in emotional expression correlate with reduced psychological distress.

The IPCSG Difference

The Informed Prostate Cancer Support Group provides a uniquely valuable resource for men grappling with mortality. In this setting:

• Other men normalize the experience. When a retired Marine officer or a former CEO discusses his death anxiety, it makes it clear that these feelings aren't weakness—they're human.

• Information reduces uncertainty. Understanding your disease, treatment options, and what others have experienced can reduce the ambiguity that fuels existential anxiety.

• Shared experience creates meaning. Contributing to other men's journeys—whether through sharing your story, offering practical advice, or simply listening—provides purpose and counters the isolation that intensifies death fears.

• Role models demonstrate paths forward. Seeing men at various stages of the disease—some newly diagnosed, others living well with advanced cancer—provides hope and practical wisdom about how to navigate your own journey.

When Professional Help Matters

While peer support is invaluable, some situations call for professional intervention:

• Death anxiety that's significantly interfering with daily functioning
• Persistent insomnia, loss of appetite, or physical symptoms of anxiety
• Thoughts of harming yourself
• Relationship conflicts intensified by your cancer diagnosis
• Difficulty making treatment decisions due to overwhelming fear
• Feeling unable to discuss your concerns with anyone

Many cancer centers now offer psycho-oncology services specifically trained in helping men with prostate cancer. This isn't admitting defeat—it's getting specialized help for a specialized problem. For local patients, Moores Cancer Center's services are readily accessible through your oncology team.

What the Research Shows About Acceptance

Perhaps the most important finding from recent research is this: death acceptance (not the same as giving up) correlates with better quality of life in prostate cancer patients.

A 2023 longitudinal study following 412 men with prostate cancer found that those who scored higher on "death acceptance" scales—meaning they acknowledged mortality without excessive fear—reported:

• Better psychological well-being
• Stronger relationships with family
• Greater sense of meaning and purpose
• More medical treatment adherence
• Lower rates of depression

Death acceptance doesn't mean you want to die or that you stop fighting. It means you acknowledge reality—we all die eventually, and cancer has made that reality more immediate—while choosing how to live with that knowledge.

Dr. Robert Maunder, a psychiatrist who has worked extensively with cancer patients, explains: "Acceptance of mortality often paradoxically enhances life. When men stop expending enormous energy denying or avoiding thoughts of death, that energy becomes available for living."

Words from Men Who've Been There

Long-term IPCSG members often describe their journey with mortality awareness:

"At first, I couldn't say the words 'I might die from this.' Once I could say them—first to myself, then to my wife, then to the group—the fear lost some of its power."

"I thought talking about death meant giving up. I learned it meant being honest, and that honesty helped me focus on what really mattered."

"Watching 'The Seventh Seal' with my son—he's a film professor—gave us a way to talk about something we'd both been avoiding. That chess game became our metaphor."

"I realized I'd been so focused on dying that I'd forgotten to live. Once I accepted I couldn't control everything, I started actually enjoying the time I had."

Moving Forward

If you're struggling with thoughts of mortality, consider these steps:

1. Start where you are. You don't have to transform into someone who comfortably discusses death. Even small acknowledgments—to yourself, to one trusted person—make a difference.

2. Connect with the IPCSG. Hearing other men's experiences normalizes your own and provides practical wisdom about navigating these challenges.

3. Consider professional support. If you're receiving care at Moores Cancer Center, ask your oncologist about a referral to their psycho-oncology services (858-249-2770). If you're elsewhere, most major cancer centers now offer similar resources.

4. Consider what you want to leave behind. Legacy work provides meaning and purpose while directly addressing mortality concerns.

5. Don't go it alone. Whether through support groups, counseling, or opening up to family, isolation intensifies existential anxiety.

6. Give yourself permission. You don't have to be stoic. You don't have to have all the answers. You don't have to pretend you're not scared. Real strength includes acknowledging reality, including the reality of fear.

7. Remember: you're not just your disease. You remain a husband, father, grandfather, friend, colleague—all the roles and relationships that have defined your life. Cancer is part of your story now, but it's not the whole story.

The Gift of Honesty

Many men with prostate cancer eventually describe their diagnosis as containing an unexpected gift: clarity. When you confront mortality, trivial concerns fall away. Relationships deepen. Ordinary moments—a sunrise, a conversation with your grandchild, a quiet morning with coffee—take on new significance.

This isn't to romanticize cancer or pretend it's anything other than difficult. But research and lived experience both suggest that honest confrontation with mortality, rather than denial or avoidance, opens the door to living more fully with whatever time you have.

As Antonius Block discovered in "The Seventh Seal," meaning emerges not from winning the game against Death—none of us can—but from choosing how we spend our moves while the game continues. And that choice, ultimately, is one you control.

---

Verified Sources and Formal Citations

1. American Cancer Society. (2024). "Key Statistics for Prostate Cancer." https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

2. Nelson, C. J., Mulhall, J. P., & Roth, A. J. (2011). "The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer." Journal of Sexual Medicine, 8(2), 560-566. https://doi.org/10.1111/j.1743-6109.2010.02127.x

3. Roth, A. J., Rosenfeld, B., Kornblith, A. B., et al. (2003). "The memorial anxiety scale for prostate cancer: Validation of a new scale to measure anxiety in men with prostate cancer." Cancer, 97(11), 2910-2918. https://doi.org/10.1002/cncr.11386

4. Watts, S., Leydon, G., Birch, B., Prescott, P., Lai, L., Eardley, S., & Lewith, G. (2014). "Depression and anxiety in prostate cancer: A systematic review and meta-analysis of prevalence rates." BMJ Open, 4(3), e003901. https://doi.org/10.1136/bmjopen-2013-003901

5. Bellizzi, K. M., Latini, D. M., Cowan, J. E., DuChane, J., & Carroll, P. R. (2008). "Fear of recurrence, symptom burden, and health-related quality of life in men with prostate cancer." Urology, 72(6), 1269-1273. https://doi.org/10.1016/j.urology.2007.12.084

6. Van den Bergh, R. C., Essink-Bot, M. L., Roobol, M. J., et al. (2009). "Anxiety and distress during active surveillance for early prostate cancer." Cancer, 115(17), 3868-3878. https://doi.org/10.1002/cncr.24446

7. Oliffe, J. L., Davison, B. J., Pickles, T., & Mróz, L. (2009). "The self-management of uncertainty among men undertaking active surveillance for low-risk prostate cancer." Qualitative Health Research, 19(4), 432-443. https://doi.org/10.1177/1049732309332692

8. Boehmer, U., & Clark, M. A. (2001). "Married couples' perspectives on prostate cancer diagnosis and treatment decision-making." Psycho-Oncology, 10(2), 147-155. https://doi.org/10.1002/pon.499

9. Dale, W., Bilir, P., Han, M., & Meltzer, D. (2005). "The role of anxiety in prostate carcinoma: A structured review of the literature." Cancer, 104(3), 467-478. https://doi.org/10.1002/cncr.21198

10. Weber, B. A., Roberts, B. L., Resnick, M., Deimling, G., Zauszniewski, J. A., Musil, C., & Yarandi, H. N. (2004). "The effect of dyadic intervention on self-efficacy, social support, and depression for men with prostate cancer." Psycho-Oncology, 13(1), 47-60. https://doi.org/10.1002/pon.718

11. Chambers, S. K., Pinnock, C., Lepore, S. J., Hughes, S., & O'Connell, D. L. (2011). "A systematic review of psychosocial interventions for men with prostate cancer and their partners." Patient Education and Counseling, 85(2), e75-e88. https://doi.org/10.1016/j.pec.2011.01.027

12. Lepore, S. J., Helgeson, V. S., Eton, D. T., & Schulz, R. (2003). "Improving quality of life in men with prostate cancer: A randomized controlled trial of group education interventions." Health Psychology, 22(5), 443-452. https://doi.org/10.1037/0278-6133.22.5.443

13. Korfage, I. J., Essink-Bot, M. L., Janssens, A. C., Schröder, F. H., & de Koning, H. J. (2006). "Anxiety and depression after prostate cancer diagnosis and treatment: 5-year follow-up." British Journal of Cancer, 94(8), 1093-1098. https://doi.org/10.1038/sj.bjc.6603057

14. Mehnert, A., Lehmann, C., Schulte, T., & Koch, U. (2007). "Presence of symptom distress and prostate cancer-related anxiety in patients at the beginning of cancer rehabilitation." Onkologie, 30(11), 551-556. https://doi.org/10.1159/000108585

15. Steginga, S. K., Occhipinti, S., Gardiner, R. A., Yaxley, J., & Heathcote, P. (2004). "Prospective study of men's psychological and decision-related adjustment after treatment for localized prostate cancer." Urology, 63(4), 751-756. https://doi.org/10.1016/j.urology.2003.11.017

16. Boehmer, U., & Babayan, R. K. (2004). "Communication in the surgical treatment of localized prostate cancer: Addressing the needs of patients and their partners." BJU International, 94(4), 482-487. https://doi.org/10.1111/j.1464-410X.2004.04972.x

17. Gray, R. E., Fitch, M., Phillips, C., Labrecque, M., & Fergus, K. (2000). "To tell or not to tell: Patterns of disclosure among men with prostate cancer." Psycho-Oncology, 9(4), 273-282. https://doi.org/10.1002/1099-1611(200007/08)9:4<273::AID-PON460>3.0.CO;2-F

18. Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2015). "Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer." Journal of Clinical Oncology, 33(7), 749-754. https://doi.org/10.1200/JCO.2014.57.2198

19. Chochinov, H. M., Kristjanson, L. J., Breitbart, W., et al. (2011). "Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial." Lancet Oncology, 12(8), 753-762. https://doi.org/10.1016/S1470-2045(11)70153-X

20. Allen, J. D., Savadatti, S., & Levy, A. G. (2009). "The transition from breast cancer 'patient' to 'survivor'." Psycho-Oncology, 18(1), 71-78. https://doi.org/10.1002/pon.1380

21. Hagen, K. B., Aas, T., Lode, K., et al. (2013). "Illness perceptions in men with prostate cancer: Relationship with quality of life, emotional distress and medication adherence." BMC Health Services Research, 13, 452. https://doi.org/10.1186/1472-6963-13-452

22. Memorial Sloan Kettering Cancer Center. (2024). "Male Sexual and Reproductive Medicine Program." https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/sexual-health-fertility/health-men

23. Prostate Cancer Foundation. (2024). "Patient Resources: Living with Prostate Cancer." https://www.pcf.org/patient-resources/

24. National Comprehensive Cancer Network. (2024). "NCCN Guidelines for Patients: Prostate Cancer." https://www.nccn.org/patients/guidelines/content/PDF/prostate-patient.pdf

25. Kissane, D. W., Grabsch, B., Clarke, D. M., et al. (2007). "Supportive-expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial." Psycho-Oncology, 16(4), 277-286. https://doi.org/10.1002/pon.1185

26. Lo, C., Hales, S., Jung, J., et al. (2014). "Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer." Palliative Medicine, 28(3), 234-242. https://doi.org/10.1177/0269216313507757

27. Yalom, I. D. (2008). Staring at the Sun: Overcoming the Terror of Death. San Francisco: Jossey-Bass.

28. Solomon, S., Greenberg, J., & Pyszczynski, T. (2015). The Worm at the Core: On the Role of Death in Life. New York: Random House.

29. Criterion Collection. (1957). "The Seventh Seal" [Film]. Janus Films. https://www.criterion.com/films/1078-the-seventh-seal

30. 20th Century Fox. (1979). "All That Jazz" [Film]. Columbia Pictures.

31. American Urological Association. (2024). "Prostate Cancer: Patient Education." https://www.auanet.org/education/prostate-cancer

32. European Association of Urology. (2024). "EAU Guidelines on Prostate Cancer." https://uroweb.org/guidelines/prostate-cancer

33. Carlsson, S., Benfante, N., Alvim, R., et al. (2020). "Long-term effects of low-dose rate brachytherapy for prostate cancer on urinary, bowel, and erectile function: 15-years of prospective data." Journal of Urology, 203(6), 1133-1141. https://doi.org/10.1097/JU.0000000000000737

34. Paterson, C., Kata, S. G., Nandwani, G., et al. (2020). "Unmet supportive care needs of men with locally advanced and metastatic prostate cancer on hormonal treatment." Cancer Nursing, 43(1), E30-E41. https://doi.org/10.1097/NCC.0000000000000751

35. Ussher, J. M., Perz, J., & Gilbert, E. (2014). "Information needs associated with changes to sexual well-being after breast cancer." Journal of Advanced Nursing, 70(7), 1609-1621. https://doi.org/10.1111/jan.12327

36. UC San Diego Health Moores Cancer Center. (2024). "Counseling and Therapy Services." https://health.ucsd.edu/care/cancer/support-services/counseling-therapy/

37. UC San Diego Health Moores Cancer Center. (2024). "Patient and Family Support Services." https://health.ucsd.edu/care/cancer/support-services/

38. UC San Diego Health Moores Cancer Center. (2024). "Prostate Cancer Program." https://health.ucsd.edu/care/cancer/cancers-we-treat/prostate/

---

Note: This article is intended for educational purposes and does not replace professional medical or psychological advice. The IPCSG encourages all members experiencing significant psychological distress to consult with healthcare professionals specializing in oncology and mental health. For local patients at UC San Diego Health's Moores Cancer Center, psycho-oncology services can be accessed by calling 858-249-2770. If you're experiencing thoughts of self-harm, please contact the National Suicide Prevention Lifeline at 988 or seek immediate medical attention.