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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.

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.

Eturauhassyövän seulonnan hyödyistä ja haitoista on käyty aktiivista keskustelua viime vuosina. Vaikka PSA-testi on laajasti käytössä terveydenhuollossa, väestötason seulontaa ei toistaiseksi suositella, sillä seulonnan haittoja pidetään hyötyjä suurempina. Seulonnan haittoja ovat ylidiagnostiikka ja siitä aiheutuvat ylimääräiset hoidot, jotka voivat heikentää miesten elämänlaatua. Artikkelissa tarkasteltiin paikallista eturauhassyöpää sairastavien miesten näkemyksiä seulonnan tarpeellisuudesta. Tutkimuksen aineisto koostui 28 eturauhassyöpää sairastavan miehen yksilöhaastatteluista. Analyysimenetelmänä käytettiin diskurssianalyysia. Suurin osa haastateltavista suhtautui myönteisesti väestötason seulontaan ja halusi parantaa miesten pääsyä PSA-mittauksiin. Seulonnan tarpeellisuutta perusteltiin argumenteilla, jotka liittyvät varhaisen diagnostiikan hyötyihin – kuten kustannusten säästymiseen ja kuolleisuuden vähentämiseen – tai miesten oikeuksiin ja sukupuolten tasa-arvoon. Tulostemme perusteella miehet ovat tietoisia seulontaan liittyvistä haitoista, mutta siitä huolimatta he ovat seulonnan käynnistämisen kannalla. Seulonta hahmotettiin miesten terveyden edunvalvontaan liittyvänä asiana.

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.

Vertaisarvioitu. English summary Psykososiaalinen tuki ei ole vakiintunut osaksi syöpäpotilaan hoitoa useista terveyspoliittisista linjauksista huolimatta. Tutkimuksessa analysoidaan, kenen tehtäväksi erikoissairaanhoidon syövänhoidossa toimivat terveydenhuollon ammattilaiset hahmottavat psykososiaalisen tuen antamisen, kuinka potilaiden tukemista tulisi heidän mukaansa kehittää sekä millaiseksi he ymmärtävät järjestöjen roolin tuen antajina. Aineisto kerättiin asiantuntijahaastatteluin syövänhoidossa työskenteleviltä terveydenhuollon ammattilaisilta (n=20). Aineiston analyysi toteutettiin aineistolähtöisellä sisällönanalyysillä. Syövänhoidossa työskentelevät terveydenhuollon ammattilaiset pitivät psykososiaalisen tuen antamista tärkeänä, mutta tuen antamisen katsottiin vaativan erityistä ammattitaitoa ja nykyistä enemmän resursseja. Haastateltavien mielestä yliopistosairaalassa on vaadittavat tukipalvelut, mutta sairaalan sisällä työnjakoa ja tuen systemaattista tarjoamista tulisi kehittää. He toivoivat sairaalaan lisää henkilökuntaa, jonka työhön tuen tarjoaminen kuuluisi. Tällöin potilaiden tuen tarpeen kartoittaminen olisi automaattisesti osa diagnoosivaiheen hoitoa. Haastateltavat kuvasivat järjestöjen tarjoamaa tukea lisänä yliopistosairaalan tukipalveluihin. He korostivat, että järjestöjen tarjoaman tuen piiriin hakeutumisen tulisi perustua potilaan vapaaehtoisuuteen ja aktiivisuuteen. Haastatteluissa tuli esiin epäilyksiä järjestöyhteistyön tiivistämistä kohtaan. Tutkimuksen tuottamaa tietoa voidaan hyödyntää kehitettäessä syöpäpotilaan kokonaisvaltaista hoitoa. Terveydenhuollon ja järjestöjen välisten raja-aitojen madaltamiseksi tarvitaan lisää tietoa järjestöjen tarjoamista tukipalveluista. Erikoissairaanhoidon henkilöstölle tarvitaan selkeämpiä ohjeita potilaiden ohjaamisesta järjestöiden palveluiden piiriin. Näiden kahden tahon välistä koulutusta syöpäpotilaan psykososiaaliseen tukemiseen liittyen tulisi lisätä. Jatkossa järjestöissä työskentelevän henkilöstön näkemyksiä erikoissairaanhoidon ja järjestöjen välisestä yhteistyöstä sekä syöpäpotilaiden psykososiaalisesta tuesta tulisi kartoittaa.

Autonomy is a pervasive concept in Western lifestyles today. However, people in the fourth age are assumed not to be autonomous but dependent on other people. The data of this study consisted of interviews with Finnish community-dwelling 90–91-year-old people. The study aim was to examine how these people see their own autonomy in their everyday lives. The analysis was based on membership categorisation analysis. Our respondents considered their autonomy through three distinct themes. Functional ability was considered in terms of being physically capable of managing daily tasks. Independence in decision making was based on material and financial self-sufficiency and on the respondents' supposition that they were capable of making decisions due to an absence of memory disorders. Additionally, autonomy was considered as contesting norms of age-appropriateness. Among respondents, chronological age seemed to have been replaced by functional and cognitive ability as a definer of categorisations; age-others became ability-others. Our study revealed that the perceptions of autonomy also included gendered features as they were linked with differing gendered ideals, roles and life domains of women and men. The results highlight the internal diversity among the oldest old and challenge the third/fourth age division. Instead, they suggest the existence of a certain ‘grey area’ within old age, and urge an analysis on the subtle meaning making involved in older people's constructions of age-categorisations.

The neo-liberal ideologies that point to individual responsibility for risks increasingly influence countries of the global North. The anti-ageing industry reflects this dictate and encourages middle-aged people to use their products and services to manage their ageing. However, given the negative connotations attached to the term ‘anti-ageing’, which is usually seen to focus on aesthetics and thus be a woman's concern, men may be likely to disavow being involved in such activities. The article uses interview data collected from men aged 42–70 from Finland and the United States of America to explore whether and how men adhere to the call to manage their ageing when such anti-ageing activities are seen to be potentially feminising. We find that these men reflected neo-liberalism in the sense that they felt that, although ageing cannot be prevented, it can be controlled. Also while they generally rejected anti-ageing products and services that they judged to affect aesthetics, they reported that they use those that they define as promoting health and performance instead. For them, masculinity is the instrumental focus on performance to the exclusion of beauty or attractiveness. Masculine anti-ageing bodily strategies must also be ‘natural’, involving hard work rather than the use of products, which they regard as never having been scientifically proven to enhance performance. Thus, in talk of their anti-ageing, men distance themselves from women.

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.