Advanced Prostate Cancer

Symptoms & side effects

One of your most important jobs as a patient will be to manage the symptoms and side effects of this disease. Most patients not only experience disease-related health issues but must manage the side effects that accompany treatment as well.

Men who know what to expect may have an easier time managing (and in some cases avoiding) the common side effects known to affect advanced prostate cancer patients (Table 1). Everyone reacts differently to various treatments, so be sure to tell your doctor about any changes in your health.

Some health issues will be a minor inconvenience, while others can cause extreme discomfort, pain and/or emotional distress. Side effects often come in one of three stages:

  • Short-term (or acute) side effects occur during treatment and typically disappear when treatment ends.
  • Long-term side effects may not completely disappear until months or years after treatment ends.
  • Late effects can occur six months or more after treatment ends.

Table 1. Most common side effects based on treatment type

Type of treatment Short-term side effects Long-term side effects Late effects
Surgery
Pain
Limited mobility and/or activities
Slow digestion
Erectile dysfunction
Scars
Impaired wound healing
Chronic pain
Change in function
Negative body image
Lymphedema
 
Radiation therapy
Skin sensitivity (redness, dryness, peeling, itchiness)
Fatigues
Anemia
Hair loss (in the area of the body being treated)
Fatigue
Dry mouth
Urinary frequency and urgency
Decline in erectile function
Bowel frequency/incontinence
Infertility
Lymphedema
Chemotherapy
Nausea and vomiting
Neutropenia (increased risk of infection)
Anemia
Fatigue
Changes in appetite
Hair loss
Mouth sores
Diarrhea
Skin and nail changes
Fatigue
Peripheral neuropathy (nerve problems)
Cognitive dysfunction (forgetfulness or trouble concentrating)
Cardiomyopathy (heart problems)
Cataracts
Infertility
Heart failure
Abnormal liver function
Osteoporosis
Hormone therapy*

Hot flashes
Constipation or diarrhea
Nausea
Dizziness and/or headache
Trouble sleeping
Erectile dysfunction and/or decreased sex drive
Weight gain
Fatigue

Increased risk of blood clot Cardiovascular disease
Diabetes
Immunotherapy
Acne-like rash
Increased risk of infection
Flu-like syndrome
Dry, itchy skin
Nausea and vomiting
Slow-growing, brittle hair
Diarrhea or constipation
Mouth sores
Anorexia
Increased risk of blood clot
Growth of eyelashes
Discomfort or tearing in eyes
Fatigue
Cardiomyopathy (heart problems)
Increased risk of blood clot
Neutropenia (increased risk of infection)
Fatigue
High blood pressure
Cardiomyopathy (heart problems)
 

*Hormone therapy is typically given for an extended period, so short-term side effects may last a long time.

 

Depression

The emotional distress of a cancer diagnosis can become so overwhelming that many patients (and caregivers) can develop depression. More complex than feeling sad or hopeless, a diagnosis of depression requires that at least five of the following symptoms occur every day for at least two weeks:

  • Persistent sad, anxious or “numb” feeling
  • Loss of interest or pleasure in once-enjoyed hobbies and activities
  • Feelings of guilt, worthlessness or helplessness
  • Fatigue and loss of energy
  • Difficulty concentrating, remembering or making decisions
  • Sleep problems
  • Changes in appetite and/or weight
  • Thoughts of death or suicide, or suicide attempts
  • Restlessness or irritability
  • Social withdrawal

Ways to manage depression

  • See a professional counselor or psychologist.
  • Ask about antidepressant or psychostimulant medications.
  • Consider joining a support group.
  • Be open with your loved ones, and ask for help when you need it.

Pain

With advanced prostate cancer, metastases to bones can cause pain in the back, pelvis and hip, or even fractures. Tumors can also press on surrounding tissues, causing back or neck pain if they press on the spinal cord. Be aware that pain can also affect your immune system and its disease-fighting abilities, interfering with your recovery.

Ways to manage pain

  • Add a pain specialist to your team.
  • Find a combination of medications that keep you comfortable, including drugs designed to strengthen the bones and inhibit bone metastases, including denosumab (Prolia, Xgeva) and zoledronic acid (Reclast, Zometa).
  • Ask your doctor about radiation therapy as a pain relief option.
  • Be careful to avoid injury.
  • Keep a diary so you can have an accurate record of your pain.

Nausea/diarrhea

Chemotherapy drugs are the most common cause of nausea and diarrhea, but other treatments and certain pain medications may also trigger these side effects. From mild to severe, these symptoms are easier to prevent than to control, so eat a healthy diet that doesn’t upset your stomach while trying various options to avoid nausea.

Ways to manage nausea and diarrhea

  • Drink a lot of water to prevent dehydration.
  • Drugs known as antiemetics can help prevent and control nausea.
  • Eat bland, low-fiber foods that are easy to digest and full of protein.
  • Avoid alcohol and caffeine.
  • Take anti-nausea medications even on days when you feel well.
  • Learn when eating is best for you, and wait at least one hour after treatment before eating.

Risk of infection (neutropenia)

A neutrophil is a type of white blood cell that plays an important role in preventing infections throughout your body. Normally, neutrophils make up 50 to 70 percent of your white blood cells. But when the number of neutrophils in your blood drops to an abnormally low level, a condition known as neutropenia occurs. Neutropenia increases your risk for infection and makes it more difficult for infections to resolve if bacteria do enter your body. The lower your neutrophil count, the greater your risk for infection.

Many types of cancer treatments are designed to attack rapidly dividing cancer cells. Because white blood cells also grow and divide quickly, they may be damaged by chemotherapy, radiation and immunotherapy, which can lead to neutropenia.

Ways to manage neutropenia

  • Wash your hands regularly, or carry hand sanitizer with you to apply often.
  • Ask about growth factor treatments, which are special proteins that stimulate the bone marrow to produce more white blood cells. Usually given as an injection under the skin, these medications include filgrastim (Neupogen), filgrastim-sndz (Zarxio), pegfilgrastim (Neulasta) and sargramostim (Leukine).

Fatigue

Men with advanced prostate cancer often experience fatigue, and they describe it using a variety of words, including “exhausted,” “weak” and “worn out.” However it’s described, the fatigue related to cancer and its treatment is different from fatigue that healthy individuals occasionally feel. It usually lasts longer, is more severe and is unrelieved by sleep. Managing fatigue is an essential part of your health care, so be sure to talk to your doctor about your fatigue.

Ways to manage fatigue

  • Set priorities for activities and do only what’s most important.
  • Participate in regular physical activity, such as walking, yoga or bike riding.
  • Take frequent rest periods or naps, but limit each nap to 45 minutes.
  • Perform deep-breathing exercises.
  • Use imagery techniques.
  • Read, listen to music and play games.
  • Ask your doctor for help managing symptoms that may contribute to fatigue, such as pain, nausea, vomiting and depression.
  • Eat a well-balanced diet to help promote healing and restore your energy.

Lymphedema

Your lymphatic system carries white blood cells throughout the body to help fight infections, but when lymph nodes are displaced by cancer cells or damaged as part of your treatment, the lymphatic fluid can build up, causing swelling in an arm or leg. Some men experience lymphedema immediately after surgery or radiation, but it can also become an issue months or even years down the road if your cancer spreads to the lymph nodes.

Ways to manage lymphedema

  • Talk to your doctor about manual lymphatic drainage (MLD), a gentle skin massage that drains lymphatic fluid into the bloodstream, reducing swelling.
  • Apply pressure with the use of a compression garment or tight bandages.
  • Clean and moisturize the affected area often to prevent infection.
  • Elevate swollen limbs to encourage drainage of the lymphatic system.
  • If you have leg edema, avoid standing still or sitting for long periods of time.

Cognitive dysfunction (”chemo-brain”)

Men being treated for advanced prostate cancer often feel as if they can’t think clearly or they have trouble remembering details such as names, dates and telephone numbers. Many say they have memory lapses in the middle of tasks or conversations and have difficulty paying attention, and they have described the overall feeling as a “mental fog.” These symptoms all represent cognitive dysfunction, which has become popularly known as “chemo-brain” because of the original belief that it was a side effect of only chemotherapy. Research has shown that cognitive dysfunction related to cancer treatment is real, affecting attention, concentration, short-term memory, language skills, organizational ability and arithmetic skills. These problems are usually subtle but can be troublesome and frustrating.

Ways to manage cognitive dysfunction

  • Ask your doctor about drugs commonly used to treat Alzheimer’s disease, as they have been effective for some men. Stimulants may also provide mental clarity.
  • Use a calendar or daily planner to keep all of your important information in one place.
  • Get physical exercise to improve mental alertness.
  • Track memory and attention problems to help you determine when you’re most affected.
  • Don’t try to multitask; focus on one thing at a time.
  • Get proper sleep, eat a balanced diet, and use humor to cope with your forgetfulness.
  • Ask for help. Let friends and family know you’re having trouble, and let them help.

Questions to ask your doctor when discussing treatment options

  • What are the possible side effects of each of my treatment options?
  • How common are these side effects?
  • When are these side effects most likely to occur?
  • How do the benefits of the recommended cancer treatment compare with the risks?
  • How long will the side effects probably last?
  • Is there a way to decrease the possibility that these side effects will occur?
  • Are there medications available to relieve or prevent these side effects?
  • How will I be monitored for long term side effects such as heart problems?
  • When should I contact a member of my health care team about a side effect?
  • Who should I call?

For more in-depth information on side effects please visit our Treatment Side Effects section.

 

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