Prostate Cancer
Supportive Care
Many people are concerned about the side effects caused by cancer treatment. Prostate cancer treatment can be accompanied by physical, emotional and sexual side effects. It is important to remember that you will not have to manage them on your own; you will be supported by your multidisciplinary team.
Before treatment begins, talk with your medical team about possible side effects and what to do if they occur. It is important to remember to communicate honestly about how you feel, both physically and emotionally, with your health care team.
Severe side effects can occur with treatment. Ask your doctor whether you are at risk, how to identify the symptoms and when to seek emergency care. Report symptoms to your health care team immediately if they occur.
Following are some of the most common physical side effects of prostate cancer and its treatment. See Table 1 for others, and ask your doctor about any side effects that you should be aware of.
Urinary Incontinence
Prostate cancer treatments, such as surgery and radiation therapy, may cause incontinence, which is the inability to control urine flow. It can range from mild to severe.
- Stress incontinence happens when the muscle that squeezes the urethra to keep urine in the bladder is weak or damaged, or the nerves that help the muscle work have been damaged. As a result, urine may leak out when you cough, laugh, sneeze, lift heavy objects or exercise. You typically sleep through the night without having to get up to go to the bathroom but have urine leak out when you stand up in the morning.
- Overflow incontinence occurs when the bladder does not empty well and the amount of urine made is more than the bladder can hold. Usually caused by a blockage or narrowing caused by scar tissue, overflow incontinence may happen when the bladder muscle cannot squeeze well enough to release all of the urine. Urine may leak throughout the day.
- Urge incontinence symptoms are similar to those with an overactive bladder. The bladder muscle, irritated by the radiation, contracts too often, sometimes powerfully enough to force urine out with little warning. Even a small amount of urine in the bladder can trigger a strong need to urinate, necessitating frequent bathroom trips.
- Continuous incontinence occurs when you have no control over the bladder and urine leaks out constantly.
Depending on the cause and whether incontinence is short term or long term, there are ways that may help manage it. The goal is to continue with your daily life with little disruption. Talk with your health care team so they can work closely with you to determine the best strategies to manage it, which may include the following:
- Pelvic floor exercises, commonly known as Kegels (pronounced KEE-gulz), may help reduce leakage from stress incontinence (see About Kegel Exercises below).
- Medications that will tighten or relax your muscles may be prescribed. They may be most helpful for urge incontinence.
- Surgery may help correct long-term incontinence. A surgeon may implant a sling to hold up the bladder or place an artificial urinary sphincter, a device that constricts around the urethra to prevent or reduce leakage. If symptoms do not improve, your doctor may implant an artificial muscle controlled by a scrotal pump to squeeze the urethra.
Erectile Dysfunction
A common side effect of prostate cancer treatment, erectile dysfunction (ED), also called impotence, is a concern of many men. ED is the inability to achieve or maintain an erection and can be caused by several factors:
- Damage during treatment to nerves or blood vessels that supply the penis
- Reduced level of testosterone in the blood resulting from hormone therapy
ED can be intensified if erection problems due to age or other reasons were present before treatment, including preoperative erectile status.
Ask your doctor which treatments may potentially cause ED, whether it will be temporary or permanent and how to manage it. Part of that discussion could include determining whether a nerve-sparing surgery would improve the chances of recovering erections.
After surgery, it takes time to fully regain erectile function. With radiation therapy, erections may not be affected immediately but may begin to fail over time. Approximately the same percentage of men have erectile dysfunction four years after either prostatectomy or radiation therapy. In general, younger men (under 60) are more likely to regain full erections after surgery than older men.
Your doctor may recommend one or more of the following to manage ED:
- Oral medications may help you achieve and maintain an erection. Tell your doctor about other medications you take to avoid negative interactions between them.
- Penile injections are drugs that may be self-injected into the erectile tissues of the penis to increase blood flow.
- Urethral suppositories are inserted into your urethra with a special applicator. The suppository melts and the drug is absorbed into the lining of the urethra.
- A vacuum erection device involves placing a small pump over the penis to increase blood flow and create an erection.
- A penile prosthesis, an implant put into place with a surgical procedure, may help restore firmness when no other treatments work. Several different types of implants are available.
- A penile constriction ring may be used with other options listed above to maintain an erection. It consists of a stretchy band that sits at the base of the penis.
Fatigue
The type of cancer-related fatigue patients may experience is due to the disease and its treatment. It is different from the fatigue that healthy individuals may feel. It can last for months or years after completing treatment. Talk with your doctor if fatigue is impacting you.
Your doctor may suggest one or more of the following:
- Exercise, even a short walk, relieves fatigue. Balance your activity with rest. Save your strength for activities that are most important.
- Maintain good nutrition. Eat a well-balanced diet of fruits, vegetables, protein and water to help promote healing and restore your energy.
- Talk with a counselor to reframe thoughts about fatigue, develop coping skills and overcome sleep problems leading to fatigue.
- Try mind-body strategies. Activities like yoga, mindfulness practices, massage, relaxation, music therapy and acupuncture may help reduce fatigue.
- Medications may help you feel more awake. If the fatigue is due to hormone therapy, certain medicines may help replace these hormones.
- Supplements may be an option to consider if your doctor finds your fatigue is related to a nutritional deficiency.
Emotional Well-Being
Facing prostate cancer and its treatment can bring up many emotions and impact your mental health. These feelings are normal, and your medical team can help you address them with services known as palliative care. The goal of palliative care is to improve your quality of life; reduce pain; treat symptoms and side effects; and address psychological, social, financial, dietary and spiritual problems caused by the disease or treatment.
Following are emotions you may have and suggestions for ways to feel better.
Anxiety is a feeling of having extra worry, the inability to relax and feeling tense. Explore counseling, support groups, meditation, deep breathing and light exercise.
Depression is a mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Consider talking about your feelings with family members, support groups or counselors; try relaxation exercises; use mindfulness and prayer; and ask about medications that may help.
Distress is the feeling of emotional, social, spiritual or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious or lonely. People in distress may also feel that they are not able to manage or cope with changes caused by normal life activities or by having a disease, such as cancer. Let your team know if you are feeling distressed.
A lack of desire for, or interest in, sex may be due to hormone changes. Be honest with your partner. You may explore other ways to be intimate.
Table 1. Common Physical Side Effects of Prostate Cancer Treatment
Contact your health care team if you experience any side effects. Some can only be detected by lab work or imaging tests, so it is important to keep follow-up appointments.| Side Effects* | Description |
| Anemia | Abnormally low red blood cell count |
| Bleeding | Blood in the urine or stool |
| Bone problems | Weak, less dense or thin bones are at higher risk for fracture |
| Bowel incontinence | Stool leakage caused by the inability to control bowel movements |
| Burning sensation | Can occur during urination with some forms of treatment |
| Chemo brain (cognitive dysfunction) | Brain fog, confusion and/or memory problems |
| Constipation | Difficulty passing stools or less frequent bowel movements compared to your usual bowel habits |
| Diarrhea | Frequent loose or watery bowel movements that are commonly an inconvenience but can become serious if left untreated |
| Dyspnea | Shortness of breath, with or without cough |
| Erectile dysfunction | Inability to achieve or maintain an erection |
| Fatigue | Tiredness that is much stronger and harder to relieve than the fatigue an otherwise healthy person has |
| Infertility | Inability to father a child |
| Lymphedema | Fluid buildup from lymph node removal that causes swelling |
| Nausea and vomiting | Upset stomach that may be prevented by anti-nausea medications |
| Neuropathy | Numbness, pain, burning sensations and tingling, usually in the hands or feet at first |
| Neutropenia | Low white blood cell count that increases the risk of infection |
| Pain | Abdominal, muscular or bone discomfort |
| Sexuality issues | Erectile dysfunction, reduced desire or feeling less desirable |
| Skin reactions | Rash, redness and irritation or dry, flaky or peeling skin that may itch |
| Urinary incontinence | Inability to control the flow of urine from the bladder |
| Urinary retention | Inability to completely empty the bladder (bladder may feel full even after urinating) |
About Kegel Exercises
When the prostate is removed, the sphincter that connects the bladder to the urethra can be damaged, leading to urinary incontinence. Consider talking to your doctor about learning to do Kegel exercises to help strengthen the muscles that can clamp off the urethra. These exercises may not eliminate your bladder incontinence, but with consistent practice, you could see an improvement.
- Find your pelvic floor muscles to squeeze. One way is to stop urinating midstream. The muscles you squeeze to stop are your pelvic floor muscles.
- Squeeze the pelvic floor muscles.
- Try to hold for 3 seconds or longer. Avoid holding your breath.
- Relax the muscles.
- Try to do 10 to 15 repetitions each time you practice.
- Repeat three times a day.
Personal care products
You may need to manage urine leaks. Talk to your health care team about products such as these that may help:
- Absorbent, washable underwear
- Adult briefs (reusable or disposable)
- Waterproof underwear
- Pads for beds and chairs
- Skin cleansers and creams
- Urine deodorizing tabletslist item
- External catheter
