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● Educational Content ● Advocacy
Ezequiel Kuperman, LCSW, MBA
● Ezequiel studied psychology and has a Master’s degree in Social Work and Healthcare Management ● Licensed clinical social worker with 22 years experience ● Ezequiel has been with Baptist Health for 16 years and the last 6 years with Miami Cancer Institute ● Ezequiel also runs a Men’s Cancer Support Group
Dina A. Mendoza, LCSW
● Dina is a licensed clinical social worker with 18 years of experience, specializing in oncology social work ● Master’s in Social Work from Florida International University and has been an LCSW since 2011 ● Currently works at Miami Cancer Institute supporting patients with genitourinary (GU) cancers ● Dina is passionate about providing guidance, resources, and advocacy to help patients and their families
Miami Cancer Institute
Beyond the Diagnosis: Nurturing your Mental, Physical & Emotional Well-Being Through Prostate Cancer
Ezequiel Kuperman, LCSW Dina Mendoza, LCSW December 16, 2025
Presentation Agenda
• Treatment Side Effects & Coping
• Mental Health Impacts of Cancer
• Emotional Well ‑ Being Strategies / Coping with Stressors during the Holidays
• Support Systems
• Community Resources
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Common Treatments for Prostate Cancer
• Effective treatments for prostate cancer range from targeted therapies to surgical options and active monitoring.
Radiation treatment – to targeted area. Androgen deprivation therapy ( ADT) - suppress hormones. Chemotherapy – systemic cancer treatment. Surgical Prostate Removal – goal to remove the cancer. Brachytherapy – implantable radioactive seeds. Active Surveillance – monitoring of low-risk prostate cancer.
Other therapies for advanced prostate cancer include radioligand therapy, radiopharmaceuticals, PARP inhibitors, and immunotherapies. Many of these treatments come with significant side effects that impact physical, mental, and emotional health.
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Men and Mental Health/Wellness
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How Cancer Affects Mental Health
• 1 out of 3 people treated for cancer in hospitals have a common mental health condition. Cancer and Mental Health | Mental Health America
• 8-24% of people with cancer also have depression. Cancer and Mental Health | Mental Health America
• Research has also shown there may be a connection between mental health and cancer survival; in one study of U.S. veterans cancer patients who also received mental health services lived longer than those who did not . Mental Health Treatment Linked to Improved Cancer Survival - NCI
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What is Distress?
• Distress includes common feelings like sadness, worry, and anger but can also be broader. • It is defined as an unpleasant experience of a mental, physical, social, or spiritual nature. Distress can affect the way you think, feel, and act. • Distress is very common among people with cancer. It is normal to be concerned about the changes in your life. Distress is expected. • Cancer brings on many challenges. It affects your body but it may also affect your relationship, work, and finances. The challenges are harder if distress is causing problems, too. Distress can affect a person’s self care, social life, mood, or faith.
NCCN distress guideline for patients, 2024
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Now that we are here and have a diagnosis lets talk about how to move forward… Just as cancer affects your physical health, it can bring up a wide range of emotions you’re not used to dealing with. It can also make existing feelings seem more intense. They may change daily, hourly, or even minute to minute. This is true whether you’re currently in treatment, done with treatment, or a friend or family member. These feelings are all normal.
Often the values you grew up with affect how you think about and cope with cancer. For example, some people:
• feel they must be strong and protect their friends and families. • seek support and turn to loved ones or other cancer survivors. • ask for help from counselors or other professionals. • turn to their faith to help them cope.
Whatever you decide, it's important to do what's right for you and not to compare yourself with others. Your friends and family members may share some of the same feelings. If you feel comfortable, share this information with them.
Emotions and Cancer - NCI
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Age Stage at Diagnosis, Mental Health, and Motivation
• Life stages affect how men think about identity, independence, work, family, and legacy. • It assists us in understanding what is important to our patients and how their life goals have an interplay. • Understanding their life stage helps us tailor support and how tailor those being treated.
- Self-Actualization Needs (maximizing your potential): it is associated with being accomplished as parent, professional, or having a strong sense of well-being - Esteem Needs (how we view ourselves and how we are seen by others): confidence, competence, strength of independence. - Love and Belonging Needs Intimacy , friendships, trust, being part of a group, connections with others.
Maslow’s Hierarchy of Needs: Purpose and Examples
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Risk and Protective Factors Explained
Protective Factors • Refer to characteristics, conditions, or behaviors that help mitigate the risk of negative outcomes and enhance an individual’s ability to cope with challenges. • The play a crucial role in promoting mental health and well being buffering
Risk Factors • Risk factors are conditions, characteristics, or behaviors that increase the probability of experiencing negative outcomes or adverse events. • They play a significant role in the development of mental health disorders, highlighting the importance of identifying and addressing these factors for preventative strategies.
individuals from potential adverse effects of their environment.
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Risk and Protective Factors in Men’s Mental Health
Protective Factors Psychological • Reliable support and discipline from caregivers • Following rules at home, school, work • Emotional self-regulation • Good coping skills and problem-solving skills • Subjective sense of self-sufficiency • Optimism
Risk Factors Psychological • Stressful life situations, such as financial problems or breaking the law • Traumatic life experiences, such as rape or serving in the armed forces • Low self-esteem, perceived incompetence, negative view of life • Poor academic achievement Social • Stressful life situations, such as financial problems or breaking the law • Traumatic life experiences, such as rape or serving in the armed forces • Low self-esteem, perceived incompetence, negative view of life • Poor academic achievement
Social • Ability to make friends and get along with others • Good peer relationships • Supportive relationship with family • Participation in sports team, club, community, or religious group
• Economic/Financial Security • Access to support services
The American Mental Wellness Association
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Physical and Emotional Challenges for Men in all stages of their Cancer Journey
Emotional Challenges • Fears and Worries • Overwhelmed & Confused • Distress • Anxiety • Sadness & Depression • Anger & Sadness • Guilt • Loneliness • Expectations after Treatment • Fear of Recurrence • Helplessness & Hopelessness
Physical Challenges • Difficulties with Sleep • Fatigue and low energy levels
• Body Image Distress • Changes in Appetite • Urinary Changes • Difficulties with Memory & Concentration • Difficulties with Intimacy & Sexual Dysfunction
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How do we address these challenges?
Cancer Survivorship Checklist
EMOTIONAL & MENTAL HEALTH • Discuss my emotional or psychological concerns related to my cancer diagnosis (including anxiety, depression, or other worries). • Ask for support or counseling for emotional, sexual, or relationship issues. • Identify support groups or patient advocacy groups where I can get support. • Ask to be connected to other cancer survivors who have gone through this before and would be willing to have a conversation.
PHYSICAL CHALLENGES • Ask for a written treatment summary and care plan for me and my current and future health care providers. This should include what my treatment was and plans for future tests and visits. Discuss with my health care team important topics, including: • What recovery from my treatment will be like. • Any physical or emotional concerns I still have after treatment ends. • Short- and long-term treatment side effects and actions to take when symptoms arise. • Screening for recurrence or for new cancers. • Diet, exercise, and other health recommendations. Review the completed plan with a member of my oncology care team to assure that I understand it.
Survivorship Checklist - NCCS - National Coalition for Cancer Survivorship
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Grief is the experience of coping with loss. Grief can accompany any event that disrupts or challenges our sense of normalcy or ourselves. This includes the loss of connections that define us.
The Five Stages Of Grief: Exploring The Kübler-Ross Model
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Denial Difficulty accepting reality of loss. For example: Believing that you don’t have cancer. Refusing to discuss cancer diagnosis. Staying busy with work or life activities to avoid confronting feelings.
Photo – pixahive.com
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Anger A normal response to a cancer diagnosis, which can manifest as an intense sense of injustice, panic, fear, helplessness and anxiety after diagnosis. For Example: Feeling frustrated with yourself and inability to fulfill your duties “This isn’t fair, why me?!”
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Bargaining Reaction or thoughts related to helplessness after, during, or after diagnosis. Characterized by attempts to reverse or lessen reality of situation. For example: “If only, thinking patterns. “If I recover from my cancer, I promise I will start going to church” “If only I had gone to a doctor sooner this might not have happened”
Photo – buzzfeed.com
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Depression Intense feeling of sadness, grief, distress or loss. One of the most common types of mental distress. Plans might become uncertain For Example: “I worked and saved for retirement only to get sick” ”How am I going to take care of my spouse?”
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Acceptance Learning to live with your diagnosis and allowing a new reality to include moments of joy and sadness in parallel frames of reference. For Example: Holding on to your sadness while still experiencing good memories of the past and maintaining hope for the future.
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You may find yourself facing new realities in your day-to-day life, including new ways of thinking, feeling, and living. You may not be able to do the same things you used to due to fatigue, health precautions, or surgery. As a result, your day-to-day routine may have changed, and you might have picked up new hobbies and routines that are a better fit for you now. Despite new challenges, some people living with cancer say the biggest change they experienced was gaining a new perspective and appreciation for life. For many living with cancer, adjusting to these changes is not about “getting back to normal” so much as discovering what normal means for you now. What is my “New Normal?”
Living With Cancer and Accepting Your New Normal
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Locus of Control is defined as the degree to which individuals perceive that they have control over the outcome of events in their lives.
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Living with Prostate Cancer – What is Within Your Control ?
The American College of Lifestyle Medicine --six pillars of lifestyle medicine OPTIMAL NUTRITION
Poor overall diet quality is the leading single cause of premature death in America. Optimal nutrition is essential to the root-cause treatment of chronic conditions. The American College of Lifestyle Medicine recommends an eating pattern based predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds. PHYSICAL ACTIVITY Regular physical activity is essential to offset a sedentary lifestyle, manage chronic conditions, and support overall health. Adults should aim for at least 150 minutes of moderate aerobic and muscle-strengthening activity per week to help prevent issues like osteoporosis and cardiovascular disease. RESTORATIVE SLEEP Unhealthy sleep is associated with the most common causes of premature death and disability, and it can lead to an increased risk of impaired memory, dementia, and cardiovascular disease. Quality sleep powerfully supports chronic disease treatment and overall well-being. Adults should strive to create the right conditions to get 7 to 9 hours of quality sleep every night to allow the body to rest and repair.
American Academy of Lifestyle Medicine
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Living with Prostate Cancer – What is Within Your Control ? (cont’d) The American College of Lifestyle Medicine --six pillars of lifestyle medicine STRESS MANAGEMENT Chronic stress can exacerbate health issues like cardiovascular disease, depression, insulin resistance, and many others. Stress management strategies are crucial for overall health as well as in the treatment of chronic disease. CONNECTEDNESS Meaningful interactions are a key factor in human happiness, longevity and the treatment of chronic diseases. Strong social connections, as well as having a sense of purpose and meaning, affect physical, mental, and emotional health, and can even reduce the risk of depression and dementia. RISKY SUBSTANCE AVOIDANCE Risky substances like alcohol, tobacco, and other drugs dramatically increase the risk of death and chronic disease and exacerbate the ill effects of disease. Other risky behaviors and exposures can negatively impact mental and physical health. Addressing these behaviors with evidence-based approaches is an essential element of health restoration.
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Tips on Managing Mental Health
• Start with a self screening. Taking an online mental health screening, such as – Mental Health America’s mental health test. , can be a first step in reflecting on one’s feelings before talking to their health care provider or a mental health specialist. • Talk to a professional. It is important for cancer patients to utilize their health care provider for information on physical and emotional health. They may be able to help with certain mental health issues and can provide a reference to a counselor or other support services. • Ask for help. Family members and friends can serve as a great support system. Cancer patients are encouraged to ask for help when they need it. • Join a support group. Talking to others who have had similar experiences can be therapeutic. Cancer patients and survivors may be able to find in-person and virtual support groups through hospitals as well as local chapters of cancer support organizations. The National Cancer Institute also offers an online directory of support services for cancer patients. • Live in the present. Finding ways to feel grounded and focused on the present moment can help to avoid feelings of worry about future events and outcomes. Prayer and spiritual practices are helpful to some cancer patients. Other options include meditation and mindfulness exercises. • Keep a journal. It can be hard to remember feelings from a week ago, let alone the entire span of cancer treatment. Tracking one’s emotions on a daily basis can serve as a reminder for an individual to reflect on how they are feeling and aid in monitoring symptoms of mental health issues. • Make time for exercise. While the ability to participate in different levels of physical activity may vary depending on one’s treatment regimen and diagnosis, exercise can play a helpful role in managing mental health. Even light walking can help with feelings of anxiety and depression.
Managing Mental Health After a Cancer Diagnosis - Nursing@Georgetown
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Self-help for men to process their feelings - tips for resilience during your cancer journey.
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Connect with other men who understand what you are going through. The beauty of the men's support group at is that it allows men to normalize their feelings and break the unwritten "code" that men don't share their feelings. Support groups allow men to deal with their emotions and receive support in a healthy way.
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Jot down your feelings on a piece of paper for five minutes. For example, you can say, "I'm really mad today or fearful about this." Once you are done, look at the paper and rip it up. This works because you get to express your feelings in a safe way, then use your masculine energy to do something about them by ripping up the paper.
Sit quietly for five minutes and take deep breaths. See whatever emotions come up as you are sitting there and let yourself feel them. If you are angry, allow yourself to feel angry. Soon the emotion will pass through you and you will move on to another feeling.
Talk to someone. You do not have to give a speech to your entire family. Just talk with someone close to you and let off a little steam so you don't compromise your health.
Managing Mental Health After a Cancer Diagnosis - Nursing@Georgetown
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Seeking Professional Help Through Evidence Based Interventions. Medical Doctor (Psychiatrist) Psychologist (PhD or Psyd) Licensed Clinical Social Worker Licensed Mental Health Counselor Licensed Marriage and Family Therapist
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Therapeutic Intervention
Cognitive Behavioral Therapy (CBT)
• Evidenced based intervention coined by Aaron Beck (1960). • Key principle that thought patterns affect emotions which in turn affect behaviors. • 40–60-minute sessions – 1 x per week. • 12 – 20 week in duration • Effective for several disorders (mood, addiction, phobias, eating disorders, chronic pain)
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Therapeutic Intervention
Acceptance and Commitment Therapy (ACT) • Coined by psychologist Steven Hayes (1994) as a contextual approach to treatment. Comes from the behavioral school of therapy. • 40-60 minute sessions • 8-16 sessions • Key point is that a more fulfilled life can be attained by overcoming negative thoughts and feelings. • A= accept the effects of life’s hardships. • C= choose directional values (kindness, connection, growth, helpful) • T= take action
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Dignity Therapy • Developed by psychiatrist, Harvey Chochinov • Key points is to relieve psychological and existential distress in patients at the end-of-life. • Treatment consists of creating a narrative of meaning for patients.
Therapeutic Intervention
The Model In Detail.
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Breathwork and Guided Imagery “The breath is the bridge between the body and the mind” Thich Nhat Hanh
Therapeutic Intervention
Types of breathwork: intended to relieve stress and reset mind body after a stressful situation • Box breathing • Diaphragmatic breathing • Purse Lip breathing • 4-7-8 breathing • Alternate Nostril Breathing Guided Imagery These are mental images to stimulate the sensory perception of all five senses that may precipitate strong emotions of feelings.
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Why Holidays are a High-Risk Period
• Increased emotional expectations.
• Social comparisons and financial strain.
• Disruptions to medical routines.
• Reduced access to regular support services.
• Grief and loss triggered by traditions.
Coping with Cancer During the Holidays.
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Why Holidays are a High-Risk Period (cont’d)
Common Warning Signs • Expressing hopelessness or feeling like a burden • Withdrawal from family, friends, or activities • Major changes in mood, sleep, or appetite • Increased alcohol or substance use How to Support Someone • Start a gentle, non-judgmental conversation • Listen without trying to “fix” everything • Encourage reaching out to mental health professionals • Help connect them with supportive friends/family
If You or Someone Else Is in Immediate Distress • Contact local emergency services • Call/text 988 (U.S.) or your country’s crisis hotline • Reach out to a trusted healthcare provider
Coping with Cancer During the Holidays.
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Tips on Managing Mental Health during the Holidays
1. Make plans to get together with friends, family or coworkers over the holidays.
5. Express your feelings in ways that help you receive the support of the important people in your life.
2. Create a new holiday season tradition that makes the most of your energy. 3. Enjoy special moments.
6. Celebrate strengths you and your loved ones have developed.
7. Be an innovative shopper or gift giver.
4. Talk to your health care team about upcoming special events.
Coping with Cancer During the Holidays.
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Tips for Caregivers during The Holidays Cancer and Mental Health: Advice for Loved Ones Talk on their terms. Be sensitive to your loved one’s feelings and encourage but do not force them to talk with you and other family members and friends about their cancer diagnosis. Listen. It is important to be there for someone who is going through cancer treatment. One of the best things to do is to listen well and fight the urge to deny or discount any negative feelings they share. Ask a health care provider. Spouses and family members who interact with their loved one’s health care team can be proactive in asking for information about cancer and mental health. If needed, they can also support their loved one by asking for a referral to support services. Join in on physical activity. Taking a walk together or engaging in other physical activities with a loved one can encourage them to keep up with exercise, benefiting their mental and physical health as they go through the cancer treatment process. Respect Boundaries. Unless they ask for input, it is often best to not push a cancer patient on medical advice or treatment options they are not interested in. Honor their autonomy and provide them with the support they ask for. Practice self care. Sometimes caretakers forget to take care of themselves. It’s important for loved ones of cancer patients to take time for themselves, stay engaged in activities, and be in tune with and honest about their emotions. Avoiding emotional burnout makes it easier to take care of the people you love.
Managing Mental Health After a Cancer Diagnosis - Nursing@Georgetown
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National Community Resources
• ZERO Prostate Cancer: ZERO360 Helpline #1-844-ZERO360 • American Cancer Society Support Line #1-800-227-2345 • NCCN Distress Management Guidelines • Local sexual health and pelvic floor PT providers • Faith-based and community programs • Prostate Cancer Foundation • Mental health America • Dial ‘988’ National Suicide Hotline • Cancer Care
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References
What Is Prostate Cancer? | Types of Prostate Cancer | American Cancer Society What Are the Survival Rates for Prostate Cancer? | American Cancer Society Zero Prostate Prostate Cancer Quick Facts One-Pager FINAL 2026.pdf Cancer and Mental Health | Mental Health America Mental Health Treatment Linked to Improved Cancer Survival – NCI NCCN distress guideline for patients, 2024 Emotions and Cancer – NCI Maslow’s Hierarchy of Needs: Purpose and Examples The American Mental Wellness Association Survivorship Checklist - NCCS - National Coalition for Cancer Survivorship The Five Stages Of Grief: Exploring The Kübler-Ross Model Living With Cancer and Accepting Your New Normal American Academy of Lifestyle Medicine Managing Mental Health After a Cancer Diagnosis - Nursing@Georgetown
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Questions
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Thank You.
Ezequiel Kuperman, LCSW Dina Mendoza, LCSW
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