Side Effects Of Prostate Cancer Treatment
The side effects of treatment vary depending on several factors, and they can be distressing. You should talk through options and concerns with your doctor before deciding which treatment to use for your prostate cancer.
Some common side effects of types of treatment include:
- Surgery many men will have temporary urinary incontinence . Almost all men will have a change to their sexual function and most men will have erectile dysfunction .
- Radiotherapy a small number of men will have bowel problems. Between 40 and 80 per cent of men who have radiotherapy will experience immediate or delayed erectile dysfunction.
- Brachytherapy erectile dysfunction and bowel problems can occur. Some men may experience painful urination and irritation of the bladder for several months after therapy. Urinary incontinence is not usually a problem.
- Hormone therapy side effects may include erectile dysfunction, tiredness, mood changes, hot flushes and loss of sex drive.
Coping with some of these side effects can be very difficult. It is important that you discuss possible side effects with your specialist before treatment.
Choosing A Prostate Cancer Surgeon
When you are choosing a surgeon to treat your prostate cancer, it is important to select someone you trust and have confidence in. He or she should have enough experience to not only perform the operation you need but also to make an informed clinical judgment and change course, if necessary.
The prostate cancer experts at Seattle Cancer Care Alliance recommend choosing a surgeon who has done at least 250 prostatectomies total and who does at least 40 a year.
As you consider your options, you might want to ask your surgeon these questions.
How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
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How Might Hormone Therapy Make Me Feel
Hormone therapy itself can affect your mood. You may find that you feel more emotional than usual or just different to how you felt before. Some men find that they cry a lot. You may also get mood swings, such as getting tearful and then angry. Just knowing that these feelings are caused by hormone therapy can help.
Everyones different some men are surprised by the side effects and how upsetting they find them. Others have fewer symptoms or are not as worried by them.
Some of the other side effects of hormone therapy are hard to come to terms with. Physical changes, such as putting on weight, or changes to your sex life, might make you feel very different about yourself. Some men say they feel less masculine because of their diagnosis and treatment.
If youre starting hormone therapy very soon after being diagnosed with prostate cancer, you might still feel upset, shocked, frightened or angry about having cancer. These feelings are normal, and it’s okay to feel this way.
Things in your day-to-day life can change because of the hormone therapy. Your relationships with your partner, family and friends might change. Or you might be too tired to do some of the things you used to do.
Some men experience low moods, anxiety or depression. This could be directly caused by the hormone therapy itself, or because you’ve been diagnosed with prostate cancer. It could also be due to the impact that treatment is having on you and your family.
What can help?
Talking about it
Prostate Cancer And Impotence
Impotence — the inability to achieve or maintain an erection — is a major side effect of most treatments for advanced prostate cancer. Among men who have both their testicles removed by a surgery known as orchiectomy, about 90% will experience impotence. Drugs to reduce testosterone levels, called androgen deprivation therapy or ADT, also causes impotence in most men. If this therapy is discontinued, many but not all men can regain erections over time, with no assistance. Treatments to improve erections include medicines taken orally or injected into the penis, vacuum erection devices,and penile implants. Discuss these options with your doctor including their likelihood of success and patient satisfaction before you have treatment that may result in impotence.
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Prostate Cancer Pain And Weakening Bones
Prostatecancer most commonly spreads to the bones. This is called bone metastases. This condition can cause pain. It can also weaken bones and make them prone to fractures. So, too, can the endocrine therapy that’s often used to slow the spread of prostate cancer. But doctors can offer treatments to relieve bone pain and support weakened bones.
Bisphosphonates to Strengthen Bones
These drugs help reduce or delay problems such as fractures caused by bone metastases in prostate cancer. The drug zoledronateà can improve bone density but is not approved to reduce fractures or bone loss in men with prostate cancer on endocrine therapy
A new class of drugs, the rank ligand antagonists, specifically denosumabà , has been found to be superior to zoledronate in reducing fractures in castrate independent prostate cancer. It is administered subcutaneously. Denosumab is also used to prevent osteoporosis caused by endocrine therapy for non-metastatic prostate cancer,
The drug toremifeneà , a serum estrogen receptor modifier used primarily for metastatic breast cancer, is can also be useful in the treatment of osteoporosis related to prostate cancer.
Both denosumab and zoledronate have the unique side effect of destroying the jaw bone. Therefore, before beginning either therapy dental disease should be addressed.
Radiation Therapy for Bone Pain
Radiation is given to reduce bone pain in advanced prostate cancer.
Surgery to Stabilize Bones
Lifestyle Changes to Maintain Bone Health
What Are The Long
A new five-year study identifies how different treatment options affect long-term bowel, bladder and sexual function.
Any man who is diagnosed with prostate cancer and faces treatment choices must grapple with the risk of side effects. Urinary incontinence and erectile dysfunction are the most common. Sometimes, these side effects are temporary and get better with time.
Until now, however, there havent been good long-term data to help oncologists help men with prostate cancer make informed choices about treatment that take these side-effect risks into account.
The new study included more than 2,000 men who were followed for five years after receiving various types of prostate cancer treatment. The resulting paper quantifies key differences in those treatments associations with long-term bowel, bladder and sexual function. The study, called CEASAR, for the Comprehensive Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer, is coordinated by the Vanderbilt University Medical Cancer and follows men who were diagnosed with localized prostate cancer between 2011 and 2012.
The 1,386 men with favorable-risk prostate cancer received one of these treatments:
The 619 men with unfavorable-risk prostate cancer received one of two treatments:
There were no clinically significant differences in bowel function after five years across the treatment types.
To read a press release about the study, .
To read the study abstract, .
Read More About:
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What Are The Prostate Cancer Treatment Side Effects Of A Prostatectomy
The primary prostate cancer treatment side effects after a radical prostatectomy are incontinence and erectile dysfunction. These side effects are a product of the location of the prostate and the type of surgery performed. The prostate gland lies deep within the pelvis behind the pubic bone and in front of the rectum. The urinary bladder lies just above the prostate, the urinary sphincter control muscle is located just below it, and the erectile nerves lie just outside the prostate on either side. A patients age and overall health also influence the potential risks of radical prostatectomy just as it does with any major operation. Such risks include cardiac or pulmonary events, infections, blood clots, or injuries to structures around the prostate.
SHORT TERM
Following surgery, all men will have some urinary leakage. A good amount of bladder control is often regained within 12 weeks and continues to improve over 12 months. Multiple studies have shown that there is often a several month interval before a patient recovers normal erections, even with bilateral nerve-sparing surgery. Advantages to the Robot Assisted Laparoscopic Prostatectomy technique are a reduced risk of intra-operative bleeding and a shortened hospital stay.
LONG TERM
What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
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Diagnosis Of Prostate Cancer
Prostate cancer is diagnosed using a number of tests, which may include:
- Prostate-specific antigen test the prostate makes a protein called PSA. Large quantities of PSA in the blood can indicate prostate cancer or other prostate problems.
- Digital rectal examination using a gloved finger in the rectum, the doctor feels for enlargement and irregularities of the prostate.
- Biopsy six to 12 tissue samples are taken from the prostate and examined in a laboratory for the presence of cancer cells.
If prostate cancer is diagnosed, more tests may be needed to see if the cancer has spread to other areas of the body. These may include computed tomography scans, magnetic resonance imaging scans and bone scans.
Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling. You can also contact the Cancer Council Helpline on 13 11 20 and speak with a cancer nurse.
When A Cure For Your Prostate Cancer Isnt Possible
If the cancer has spread and it is not possible to cure it with surgery, your doctor may still recommend treatment that focuses on improving quality of life by relieving the symptoms . Medications can be used to relieve pain, nausea and vomiting. The Cancer Council Victoria booklet called Living with advanced cancer may be helpful to read.
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Prostate Cancer Expertise At Scca
Data collected from cancer centers across the country show that men who begin their prostate cancer treatment at SCCA have higher survival rates on average than those who started treatment at other centers.
We have world-class urologic oncologists, medical oncologists, radiation oncologists and pathologists who specialize in prostate cancer the most advanced diagnostic, treatment and recovery programs and extensive support.
SCCA patients have access to advanced treatments being explored in ongoing prostate cancer clinical trials conducted at SCCA, Fred Hutch and UW Medicine. Our doctors and scientists are at the forefront of research to better prevent, diagnose and treat prostate cancer and to improve quality of life for survivors, including through the Institute for Prostate Cancer Research, a Fred HutchâUW Medicine collaboration.
Your SCCA doctors will explain all your options and recommend a treatment plan based on the grade and stage of your prostate cancer and several other factors, including your age, your general health, potential side effects and the probability of curing your disease, extending your life or relieving your symptoms.
Transurethral Resection Of The Prostate
This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.
During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.
The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.
You will probably have some blood in your urine after surgery.
Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.
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How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
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Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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