Advanced Prostate Cancer

Managing Symptoms

How you manage the symptoms of advanced prostate cancer and the side effects of treatment has a major impact on your quality of life. The diagnosis alone can create fear, anxiety or depression for some men. Learning what to expect from both the disease and the treatment options can give you a sense of control and confidence in making the decisions ahead. Ask your doctor or nurse to explain instructions and any medical terms that are unclear to you, and seek help as soon as you feel you’re having trouble coping with the illness. Resources and support services at your hospital and in the community can provide assistance. In addition to friends and family, social workers, support groups, counseling and mental health services can help you feel that you are not alone when you are stressed or overwhelmed.

Although you may not experience symptoms of advanced prostate cancer, some side effects are common to both prostate cancer and its treatments. The symptoms that occur most frequently include:

  • urinary problems
  • erectile dysfunction (difficulty having an erection, impotence)
  • pain or discomfort in your pelvic area, spine, hips, ribs or other bones

Bowel problems may also occur during or after treatment, and various side effects are associated with hormone therapy, radiation therapy and chemotherapy.

Urinary problems

Among the urinary problems you may experience are a burning sensation with urination, a weak urine stream, blood in the urine, and incontinence (inability to control urination). There are three basic types of urinary incontinence:

  • Stress incontinence: You leak urine when you cough, sneeze, laugh or rise from a sitting position.
  • Urge incontinence: You are unable to get to the bathroom in time.
  • Overflow incontinence: You don’t empty your bladder completely when you urinate.

Most incontinence in men with prostate cancer is due to prior therapy (radiation, surgery) rather than being direct effects of the cancer. Sometimes the prostate tumor may press on the urethra (the tube that carries urine out from the bladder), restricting or even blocking the flow of urine and causing pain and enlargement of the bladder. Some degree of incontinence is likely after radiation therapy if the muscles or nerves that control the release of urine are damaged. Incontinence may disappear in a few weeks or months, but for some men it may take several years for incontinence to resolve or it may be a lasting problem.

Managing urinary problems

A variety of options may help manage urinary problems:

  • Medications that improve urinary flow, such as tamsulosin (Flomax) and terazosin (Hytrin)
  • Medications that calm an irritated bladder, including tolterodine (Detrol) and solifenacin (VESIcare)
  • Kegel exercises, which involve contracting and relaxing the muscles of the pelvis, helping you to maintain better control of urination
  • Devices to collect urine or stop leakage, such as a condom catheter, which fits over the penis and drains urine into a storage bag, or a penile clamp, which stops urine leakage with a V-shaped foam cushion that presses on the urethra
  • Injection of collagen into the urethra, which narrows the passageway for urine
  • Surgical procedure to provide support to the urethra and relieve pressure on the bladder

Talk with your doctor about specific treatments that might benefit you, depending on the particular urinary problem or type of incontinence you have.

Erectile dysfunction (impotence)

Erectile dysfunction or impotence is the inability to have and sustain an erection. Both surgery and radiation therapy may cause impotence and/or sterility if damage occurs to veins or nerves that help achieve and/or maintain an erection. Because these nerves and blood vessels are delicate, they can be damaged even if treatment is given with great care. ADT may also cause impotence and loss of sexual desire by eliminating testosterone. Impotence may be temporary or long-lasting, so if you want to be able to father children, you may wish to consider using a sperm bank before treatment.

The emotional impact of impotence can be very important, causing feelings of anger, sadness, frustration or lack of confidence. Often, men with impotence will avoid sexual contact, causing their partner to feel rejected or inadequate. However, couples can achieve intimacy and express affection in ways other than sexual intercourse by touching, caressing, massaging, holding, hugging and kissing. You may consider seeking sex therapy treatment as a couple or alone.

Managing erectile dysfunction

Your sexuality doesn’t have to be completely dependent on the ability to have an erection, but your doctor can suggest a number of ways to improve your ability to have an erection, including:

  • penile injections
  • vacuum erection devices
  • penile implants
  • urethral suppositories

Oral medications for erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), may be beneficial but must be used with care in men who take nitrates or alpha-blockers for high blood pressure, heart disease or urinary control.

Pain

Men sometimes feel they shouldn’t complain about pain, that they should just be brave and bear it. But pain is a stress on your body and can affect your immune system and its disease-fighting factors. Not only can pain hurt your spirit, it can interfere with your recovery. If you are in pain, you may feel:

  • angry
  • anxious
  • depressed
  • worried
  • lonely
  • tired

Controlling pain is part of your cancer treatment. Numerous medications are available for a wide range of pain, from mild to severe. Don’t “save” pain medication for a later time; the best way to control pain is to stop it early or keep it from getting worse. It may be helpful to keep a diary of pain you experience. You might list:

  • when you take pain medication
  • name and dose of the medication you take and its effect
  • length of time the medication works
  • any side effects from the medication
  • other methods that provide relief for your pain
  • activity that makes the pain worse or makes it better
  • things you’re unable to do because of pain

With advanced prostate cancer, metastases to bones can cause pain in the back, pelvis or hip and even fractures. As the tumor grows, it may cause pain by pressing on tissues around it, and back or neck pain may result if a tumor spreads to the spine and presses on the spinal cord. Radiation therapy may help prevent or treat fractures and provide pain relief, and your doctor may also prescribe a pain reliever.

Metastases to the liver may cause abdominal pain, and cancer that has spread to the lungs may result in a persistent cough and chest pain. Some medical procedures used to diagnose cancer or see how well treatment is working, such as biopsies or bone marrow tests, are painful or cause discomfort.

You are entitled to having a doctor totally committed to relieving any pain you may experience as a result of cancer and its treatments, and one who also makes sure that any side effects from attempts at pain control are acceptable to you. So, if you don’t already have someone like that on your health care team, ask for a referral to a pain specialist.

Bowel problems

Bowel problems are more common following external-beam radiation therapy than any other primary therapy and may include:

  • diarrhea
  • inability to control bowel movements (fecal incontinence)
  • bleeding from the rectum
  • dry, red, tender skin at the site of radiation

Managing bowel problems

Antidiarrheal medicines, such as diphenoxylate, atropine (Lomotil) and loperamide (Imodium), help control diarrhea. In addition, you should avoid foods that can irritate the stomach and intestines, such as spicy or greasy foods. Taking fiber supplements or eating more whole grains, fruits and vegetables can also help by adding bulk to the material in your intestines. Laser therapy may be used to stop rectal bleeding caused by radiation, and special ointments or creams can soothe skin that is tender from radiation treatments.

Side effects of hormone therapy and chemotherapy

As noted earlier, hormone therapy may cause several side effects (Table 1). But many of the side effects are treatable, and most go away once treatment is finished. Among the most common side effects of standard chemotherapy (such as docetaxel and cabazitaxel) are low blood cell counts. A low number of white blood cells can increase your risk of infection, and a low number of red blood cells (a condition known as anemia) can make you feel weak and extremely tired. Your health care team will check your blood cell counts periodically; if your counts are low, your chemotherapy may be delayed until the counts return to a more normal level.

People react differently to chemotherapy, and side effects vary with different treatment combinations and different types of cancer. Although your doctor or nurse will tell you what you may expect from the regimen you will receive, be sure to tell them what side effects you experience. Many side effects are mild, treatable and will go away after chemotherapy is finished (Table 1).

Table 1. Potential side effects of hormone therapy and chemotherapy

Side Effect Management Options
Enlarged and/or tender breasts (gynecomastia) Your doctor may recommend a single low dose of radiation before hormone therapy begins or suggest other drugs (tamoxifen or raloxifene).
Hot flashes (flushes) Your doctor may suggest medications or low doses of estrogen or progesterone.
Loss of muscle mass Lift weights and maintain an active lifestyle.
Fluid retention (swelling of hands, legs and feet)
Limit salt and salty foods.
Raise feet when sitting.
Stay active (walk, ride a bike).
Fatigue
Get eight hours of sleep every night.
Take short naps when needed.
Exercise every day.
Eat a healthy diet and drink plenty of water.
Hair loss Be patient; your hair will grow back, but the color or texture may change.
Mouth or lip sores
Use a very soft toothbrush and brush after eating and before bed.
Use a mouth rinse of 1 cup warm water, 1/4 teaspoon baking soda and 1/8 teaspoon salt.
Choose soft foods and avoid spicy foods, citrus juices, alcohol and drinks containing sugar.
Avoid smoking.
Nausea and vomiting
Take your anti-nausea medicine even on days when you feel well.
Learn when eating is best for you and wait at least one hour after treatment before eating.
Neuropathy (pain, tingling or burning sensation in hands and feet) Do stretching exercises each day.
Avoid snug shoes or socks and extreme hot or cold temperatures.
Your doctor may prescribe medication to relieve pain.

Additional Sources of Information

 

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