Prostate Cancer

Understanding side effects

The physical and emotional side effects associated with prostate cancer are often related to treatments rather than the cancer itself. Because side effects can significantly affect your daily life, it is important to understand the potential side effects of different treatment options before you decide on a treatment.

Typical physical side effects, such as urinary and bowel problems, erectile dysfunction (ED), pain and fatigue, often are accompanied by emotional side effects, such as fear, anxiety and depression. It is important to remember that not all patients experience the same side effects, even if they receive the same treatment. The type, length and intensity of symptoms will depend on how your body responds to treatment. Following are the common side effects of each type of prostate cancer treatment.

Surgery

The effects from an open radical or robotic-assisted laparoscopic radical prostatectomy will depend on the extent of the surgery and whether any nerve damage occurs. Incontinence and ED are typical, but may resolve themselves over time. Normal bladder control may return in weeks or months, and recovery is gradual. Kegel exercises may help to reduce urine leakage. In some cases, the effects of surgery are permanent. If the conditions persist, they can often be corrected, and your doctor may recommend products, medications or surgery to help improve them.

Pain, bleeding and postoperative infections are additional risks of surgery. Fatigue often follows surgery but usually subsides with time.

 

5 tips for fighting fatigue

Fatigue is the most common side effect of cancer treatment. Different from the fatigue that healthy people feel, fatigue in people with cancer isn’t relieved by extra rest. It may subside after treatment, but it could last for months or even years after treatment ends. The long-lasting effects of fatigue can cause mental fatigue and emotional distress, affecting your ability to think clearly or even work at your usual job. If these tips don’t help, talk with your doctor. Don't let fatigue affect your quality of life.

  1. Sleep 7-8 hours at night, and take short naps (30 minutes or less) during the day.
  2. Stay active. Believe it or not, exercise — even a brief walk — decreases fatigue.
  3. Know your limits. Conserve your energy for important activities.
  4. Eat a healthy diet, filled with fruits, vegetables, protein and water.
  5. Join a support group to find out how other patients with cancer handle fatigue.   

Cryosurgery/cryotherapy

Blood in the urine, soreness in the area where the needles were placed and swelling of the penis or scrotum typically occur for a short time after cryosurgery.

Freezing can affect the bladder and intestines, which can lead to pain, burning sensations and the need to empty the bladder and bowels often. Most men recover normal bowel and bladder function over time. Urinary incontinence is rare in men who opt for cryosurgery as their first treatment for prostate cancer, but it is more common in men who have had radiation therapy. Freezing may damage the nerves near the prostate that control erections.

In rare cases, a fistula (an abnormal connection) may develop between the rectum and bladder, which causes urine to leak into the rectum. This is a serious condition that often requires surgery.

Hormone therapy

Side effects of orchiectomy (removal of the testicles) and luteinizing hormone-releasing hormone (LHRH) analogs include reduced sexual desire, hot flashes, breast tenderness, breast enlargement, shrinking of the penis and testicles, osteoporosis, anemia, decreased mental sharpness, loss of muscle mass, weight gain, fatigue, high cholesterol and depression.

Some side effects of hormone therapy for prostate cancer can be managed. Medications can help prevent and treat osteoporosis. For more on bone health, click here. Depression can be treated with counseling, antidepressants or both. If you can exercise safely and comfortably, the right amount of exercise can help you feel less tired, counteract weight gain and improve your mood.

Anti-androgens may have fewer side effects than LHRH analogs. When these drugs are used alone, sexual desire and erections can often be maintained, though diarrhea, nausea, liver problems and fatigue may occur. When these drugs are used along with LHRH agonists, side effects of LHRH analogues as well as those of antiandrogens may occur.

Radiation therapy

Diarrhea, frequent urination and a burning sensation during urination can occur after radiation therapy to the prostate/prostatic fossa (the area where the prostate is located). Skin in the treated area may become dry, red and tender, and you may lose hair in the area (temporarily or permanently). The lining of the bladder, rectum or small intestine may become inflamed, resulting in frequent urination, frequent bowel movements or bleeding. Rarely, urinary or bowel incontinence may occur. Loss of erections may occur over time after treatment.

If you have diarrhea, your doctor may recommend an anti-diarrheal medication. You should not take any anti-diarrheal medication without asking your doctor first. Diarrhea can cause dehydration, so be sure to drink plenty of fluids. To help with diarrhea, avoid coffee, tea, sweets and fried, greasy or spicy foods.

Fatigue that inhibits daily activities is common and is sometimes long-lasting. The level of fatigue differs among patients and may be more severe for patients who had sleep problems or depression before therapy.

Chemotherapy

People who have chemotherapy may experience a variety of side effects. Some of the possible side effects that you may or may not incur include fluid retention (leading to foot and leg swelling), mouth sores, weakness, bleeding or bruising, neuropathy (pain or tingling in the feet and hands), nausea, vomiting and diarrhea. Chemotherapy may also cause hair loss, including loss of eyebrows, eyelashes or body hair. Most of these side effects stop once treatment concludes.

If you have neuropathy, your doctor may prescribe pain medications, steroids or numbing creams or lotions. Wearing comfortable shoes, keeping your hands and feet warm and avoiding standing or walking for too long may also improve your symptoms.

Your doctor can recommend prescription or over-the-counter medicines to help with your nausea during treatment.

Patients typically experience fatigue in the days immediately after treatment. Pain, depression, anxiety, lack of sleep and anemia can intensify the feeling. Fatigue usually decreases after treatment ends, but it may take months or longer for it to disappear completely.

Immunotherapy

Mild side effects include mouth sores, fatigue, high blood pressure, fluid buildup in the legs, and flu-like symptoms such as fever, chills, fatigue, nausea, headache, and back and joint pain. More serious reactions are also possible, including shortness of breath, wheezing, dizziness and stroke. You are encouraged to talk with your doctor about nutrition, physical therapy and medication as ways to manage these effects.

This content contains more detailed information about managing incontinence, sexual side effects and depression in the following sections. As always, talk with your doctor if you begin to experience any side effects.

Questions to ask your medical team

  • What are the possible side effects of each of my treatment options?
  • How common are these side effects?
  • Can I do anything to make it less likely that I have these side effects?
  • When are these side effects most likely to start?
  • How long do the side effects last?
  • Are there medications or other ways to relieve these side effects?
  • How severe can the side effects be?
  • When should I contact a member of my treatment team about a certain side effect and whom should I contact?

Additional Resources

 
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