Cancer-related masculine threat, emotional approach coping, and physical functioning following treatment for prostate cancer.

OBJECTIVE: Aspects of masculinity and gender role, particularly those that are traditional and restrictive, are related to poorer physical and psychological outcomes in men with cancer. This longitudinal study uses a cancer-specific assessment to determine whether cancer-related masculine threat (CMT) predicts prostate-related (i.e., urinary, bowel, sexual) functioning over time, and whether cancer-related emotional approach coping (EAC) processes explain these relationships. Whether coping self-efficacy and emotional suppression explain effects of CMT on EAC also is tested.

METHODS: Sixty-six men (M age = 65.76; SD = 9.04) who underwent radical prostatectomy and/or radiation therapy for localized prostate cancer within two years were assessed on physical and psychological variables at study entry (T1), and two (T2) and four (T3) months later.

RESULTS: Analyses controlling for baseline functioning and age revealed that CMT predicted declines in (T1 to T3) urinary (B = -.21, p < .05), bowel (B = -.24, p < .05), and sexual (B = -.17, p < .05) function. CMT also predicted decreased emotional processing (T1 to T2), but not emotional expression. Decreased emotional processing predicted declining prostate-related functioning and helps explain the effect of CMT on bowel and sexual (but not urinary) functioning. Low coping self-efficacy (p < .05), but not emotional suppression, was a mechanism by which CMT predicted emotional processing.

CONCLUSIONS: The extent to which men believe that cancer is inconsistent with their masculinity exacerbates declines in prostate-related functioning following cancer treatment. CMT likely shapes coping responses and negatively affects the efficacy of emotion-directed coping. Emotion-regulating coping processes, particularly the ability to process cancer-related emotions, appears to be one pathway through which gender role affects recovery from prostate cancer.