Stress associated with a life threatening illness contributes to poor adjustment and psychological and physiological consequences harmful to adaptation and recovery from surgical treatment. Cancer and its treatment are associated with considerable distress, impaired quality of life, poor mental health, and reduced physical function. This is particularly true for men with prostate cancer undergoing a radical prostatectomy (RP), the surgical treatment of prostate cancer. Recovery from RP is often associated with urinary and sexual dysfunction in addition to more common sources of stress associated with surgery. At least 50 percent of RP patients have permanent impotence and many experience prolonged periods of urinary incontinence. In addition to the distress associated with these quality of life changes, prostate cancer patients face the fear of recurrence, progression, and death. Recent research has found that psychosocial and psychoeducational interventions can increase quality of life and mental health of cancer patients, and may also improve immune status, pain indices, hospital costs, and length of survival. Despite the dramatic increase in research on psychosocial aspects of cancer and of interventions for cancer patients, relatively little work has considered prostate cancer or the specific impact of surgery for cancer. The proposed study will randomly assign prostate cancer patients undergoing RP to a pre-surgical stress management group, an attention control group, or a usual care control group. Dimensions of response to surgery and recovery will include measures of mental health and psychological status, quality of life, and immune, endocrine, and cardiovascular function, as well as pain, use of analgesic medication, and length of hospital stay post- surgery. This design will allow characterization of distress associated with prostate cancer and RP and examination of psychological, physiological, and quality of life changes associated with surgery and short- and long-term recovery. We will also evaluate a theoretical model developed to examine dispositional and environmental factors as predictors of response to surgery and long-term recovery. We hypothesize that pre-surgical stress management will reduce the negative impact of RP assessed by psychological, physiological, and quality of life measures.
