Prostate cancer-related sexual dysfunction - the significance of social relations in men's reconstructions of masculinity.

Narrating illness experiences in a culturally acceptable manner is essential for retaining quality of life after the disruptive event of being diagnosed for prostate cancer. Psychological pressures caused by treatment side-effects such as erectile dysfunction require reinterpretation of the meanings and impacts of these side-effects on masculinity. This helps maintain coherence in men's lives. We studied how men employ culturally available discursive strategies (compensation, redefinition, recontextualisation, and normalisation) in reconstructing masculinity and sexuality. Our data consists of 22 interviews of heterosexual Finnish prostate cancer patients who had undergone surgery. The aim was to analyse the ways in which various life situations and social relations shaped and limited the use of these strategies. Discourse analysis revealed that older age, a supportive spouse, children, supportive male friends, and good health - were key elements men used in reconstructing a coherent new self-image and conception of life following cancer treatment. Men with sexually active male friends, men without families, younger men and men with new intimate relationships struggled to develop a new version of their masculinity. Being able to effectively utilise certain aspects of one's life situation in re-constructing masculinity is important in maintaining quality of life despite troublesome treatment side-effects.

Missingness in the expanded prostate cancer index short form (EPIC-26) - prevalence, patterns, and explanatory factors.

BACKGROUND: Researchers and clinicians using common clinical assessments need to attend to the prevalence of missing data to ensure the validity of the information gathered. The Expanded Prostate Cancer Index Short Form (EPIC-26) is a commonly used measurement scale used for assessing patients' quality of life, but the measure lacks comprehensive analysis on missing data. We aimed to explore the quantity of missing answers in EPIC-26 and to characterize patterns and possible explanations of missing data in the survey. METHODS: The survey sample consisted of 625 Finnish prostate cancer patients who participated in a study with a 1-year follow-up with three measurement points (0, 6, and 12 months). Descriptive statistics were used to describe the study population and missingness level. A logistic regression was performed for each EPIC domain to study factors related to missingness during the follow-up. RESULTS: Proportions of missing answers in EPIC-26 were low (3.1-3.9%) between survey rounds. As much as 37% of patients left at least one question unanswered during their follow-up. The hormonal domain produced the most missing answers. Questions about breast tenderness/enlargement (question 13.b.), hot flashes (question 13.a.), frequency of erections (question 10.), and ability to reach orgasm (question 8.b.) were most frequently left unanswered. Higher age, lower education level, no relationship, more severe cancer, lower function scores in some EPIC domains, lower treatment satisfaction or self-rated health were associated with missingness. CONCLUSIONS: Questions 13.b. and 13.a. might be considered female-specific symptoms, thus difficult to comprehend unless patients had already experienced side effects from androgen deprivation therapy. Questions 10. and 8.b. might be difficult to answer if the patient has been sexually inactive. To improve the measure's validity, the questionnaire's hormonal section requires additional explanation that the inquired symptoms are common treatment side effects of anti-androgen therapy; questions 8-10 require a not-applicable category for sexually inactive patients.

Studying constructions of aging manhood: Methodological considerations.

The study of aging masculinity benefits from theories of intersecting inequality and attention to context, and also from methodological care. Theory can help to avoid reification of naturalized distinctions by age and by sex; and methodological rigor can avoid imputations of old masculinity to activities that other people do just as much. We revisit published research to outline theory and methods that minimize risk of reification and false distinction. We review theories of intersecting inequalities (age and gender) as well as institutional context; and we focus on methods that require either explicit mention of gender by those studied or direct comparison of old men to others. We offer several examples of how we can distinguish aging masculinities by using these methods, from interview research to the study of popular culture. Comparisons of white, middle-aged men in Finland to men in the U.S., and contrast of the U.S. men to U.S. women, reveal patterns in their constructions of manhood in later life, in realms of health, anti-aging, and caregiving. We point to the importance of both intersectionality and attention to contexts, such as welfare states, which shape aging manhood.

The expanded prostate cancer index composite short form (EPIC-26) for measuring health-related quality of life: content analysis of patients' spontaneous comments written in survey margins.

INTRODUCTION: This study investigates comments that prostate cancer patients spontaneously write in the margins of the Expanded Prostate Cancer Index Short Form (EPIC-26) questionnaire. We aim to show the possible barriers that patients face while answering the survey, and to consider how these barriers may affect the response data generated. We investigate the kind of information patients' comments on EPIC-26 contain, and patients' motivations to provide this information. We also study why some EPIC domains spark more comments than others. METHOD: We analyzed 28 pages of transcribed comments and four pages of supplementary letters from our survey participants (n = 496). Using inductive content analysis, we generated 10 categories describing the content of participants' comments, and four themes demonstrating their motives for commenting. The comments regarding each EPIC domain were quantified to discover any differences between domains. RESULTS: The sexual domain of EPIC-26 provoked over half of all comments. Patients without recent sexual activity or desire had difficulties answering sexual function questions 8-10. The lack of instructions on whether to take erectile aid use into account when answering erectile function questions led to a diversity of answering strategies. Patients with urinary catheters could not find suitable answer options for questions 1-4. All domains sparked comments containing additional information about experienced symptoms. CONCLUSION: Patients are mainly willing to report their symptoms, but a lack of suitable answer options causes missing data and differing answering strategies in the sexual and urinary domains of EPIC-26, weakening the quality of the response data received.

Factors related to self-rated health and life satisfaction one year after radical prostatectomy for localised prostate cancer: a cross-sectional survey.

BACKGROUND: Localised prostate cancer affects patient's quality of life in many ways. The aim of this study was to explore factors related to self-rated health and life satisfaction for patients treated for prostate cancer, and to compare the results of these generic quality-of-life measures to the prostate cancer-specific quality-of-life measure (UCLA Prostate Cancer Index), which focuses on physical functioning. MATERIAL AND METHODS: This cross-sectional survey was carried out among 183 men who underwent radical prostatectomy in 2012-2015 at a university hospital in Finland and were seen 1 year postsurgery. Approval from an ethics committee and written consents from participants were received. A questionnaire was used to evaluate patients' perceived quality of life. Logistic regression model, Spearman's correlation, Kruskal-Wallis test and Mann-Whitney U-test were used to analyse factors related to quality of life. RESULTS: Of the 183 men in the study, 63% rated their health status as good, and 70% were satisfied with their lives after prostatectomy. Older age and better urinary function were the only factors that explained both better self-rated health and better satisfaction with life. The patients seemed not to interpret problems with sexual function as health-related problems. In our sample, sexual dysfunction was relatively severe, but patients considered them to be less harmful than urinary or bowel symptoms. Interestingly, 24% of the men with low sexual function did not find that dysfunction bothersome. CONCLUSIONS: Objectively measured physical functioning is not necessarily in line with patients' experienced satisfaction with life and their self-ratings of health. More longitudinal and qualitative research is needed about the meanings that patients attach to physical treatment side effects and the extent to which they can adapt to them over time. With a bigger sample and longer follow-up time, it would be possible to identify men who particularly benefited from pretreatment counselling.

Seeking certainty through narrative closure: men's stories of prostate cancer treatments in a state of liminality.

Radical treatments of prostate cancer often lead to a pervasive liminal state that is characterised by multiple uncertainties that relate both to a possible recurrence of cancer and recovery from side effects, such as erectile and urinary dysfunctions. Liminality can make it difficult for cancer patients to narrate their experiences, as their stories lack a definite ending. After interviews with 22 Finnish men who had undergone radical prostatectomy, we analysed how men produce closure in their illness narratives. Focusing on the timelines of control visits or their anticipated recovery from side effects, these interviewees sought provisional certainty within a seemingly chaotic future. By locating erectile dysfunction in the wider context of a life-course and interpreting their fading sexuality as a 'natural' consequence of ageing, these men were adjusting to their post-operative lives. Our study further shows that the inability to adjust personal experiences to positive culturally available storylines that provide a chance for the narrative reconstruction of life, can cause materialised negative consequences, such as relationship breakdowns.

Rationales for Anti-aging Activities in Middle Age: Aging, Health, or Appearance?

PURPOSE: We explore the motivations of middle-aged consumers of anti-aging products and services in relation to aging, health, and appearance. Admission of use of anti-aging products and services could align a respondent with a stigmatized group, old people, and also connotes a feminine concern with aesthetics. For these reasons, people, particularly men, will be unlikely to report using them for this purpose. DESIGN AND METHODS: Semi-structured, in-depth interviews were conducted among 19 men and women aged 42-61 years. Topics included their perceptions of bodily changes and their responses to these. We analyzed data qualitatively. RESULTS: Respondents frame their uses of anti-aging products in terms of health and appearance, not anti-aging per se. Both men and women see anti-aging as related to beautiful appearance and thus as a feminized activity. Both are concerned about appearance, but in gendered ways. Overall, respondents conflate bodily appearance, health, and aging in their constructions of anti-aging. IMPLICATIONS: This conflation maintains inequality by stigmatizing old age as unhealthy and unseemly. Our results point to the limits of studying the consumption of anti-aging products and services if researchers ask only about anti-aging uses per se. They also point to the ways that discourses of health and appearance naturalize ageism, as they suggest that old age inheres in bodies that "naturally" decline and thus should be excluded.

Immune to ageism? Men's perceptions of age-based discrimination in everyday contexts.

Despite long-term, conceptually and theoretically refined discussions, the phenomenon of ageism still remains empirically under-developed. To better understand the diversity of ageism, its contextual variations and gender-specific dynamics in people's daily lives, this study focuses on how different interactional contexts shape men's perceptions of ageism. Using data from 67 thematic personal interviews with 23 middle and working class men aged 50-70, this study contributes to the sorely lacking, empirically based and nuanced understanding of how ageism is experienced, and adds to the research on the internalization of ageism which to date has primarily focused on older women's experiences. Key findings are as follows: 1) men are not totally immune to ageism, but rather, 2) the experiences and interpretations of ageism are structured by the interactional context in question, 3) acts and expressions interpreted as discriminative in one context become defused in others, and that 4) in family contexts positive ageism represents a naturalized order of things within intergenerational relations. The study contributes to the existing body of work on age negotiations and on the ways in which chronological age as a cultural resource functions in interaction. It also underlines that adopting a gender and context sensitive approach into ageism opens up promising avenues for further conceptual development.

Aging male bodies, health and the reproduction of age relations.

This article explores the ways in which a group of male factory workers uses bodies as bases for hierarchical categorization of men by age in their talk of mundane aspects of their lives. Analysis of interviews about health (4 focus groups and 5 personal interviews) with Finnish working-class men under 40 years old shows that they portray age groups to which they do not belong as careless, even irresponsible toward health and its maintenance. As they categorize youth and old people by age, they leave themselves unmarked by it, providing no vocabulary to describe their own group. Despite their tendency to distance themselves particularly from old people, they also distinguish among older men by familiarity, providing relatively nuanced accounts of their fathers' aging. We discuss the marking of age groups in terms of social inequality and talk of fathers in terms of intergenerational relations. Even family ties among men of diverse ages involve ageism, which familiarity serves both to mitigate and to make less visible. This article documents the maintenance of age inequality in everyday, mundane behavior.

Men, bodily control, and health behaviors: the importance of age.

OBJECTIVE: To conduct an intersectional analysis of relations between gender and age in the health behaviors of middle-aged men, informed by cross-national comparison between Finland and the United States. METHODS: Thematic and discourse analysis of data from interviews conducted among professional and working-class, middle-aged men in the U.S. and Finland. RESULTS: Respondents report that middle age inspires them to regard many bodily changes as more than transitory; and they assume a sense of responsibility that can lead to greater self-care. Men reported using such strategies as discipline, routine, and monitoring in their attempts to forestall aging. CONCLUSIONS: The men face contradictions: While they may adopt ideologies of masculinity and control and accept responsibility for influencing their health, their bodies may also present them with age-based limitations to their abilities to do so. How men respond to these changes varies by context, including their aging and these nations' different systems of health care.