Do What You Can to Ease Side Effects of Treatment for Advanced Prostate Cancer

It’s likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. The side effects depend on your treatment, and that depends on how much the cancer has spread from your prostate. In this section, you’ll learn more about how to respond to some of the most common side effects and symptoms from treatment of prostate cancer.

We’ve listed, in alphabetical order, some common side effects from treatments for prostate cancer and how to ease them.

Anemia (low red blood cell levels)/tiredness and fatigue

Tiredness is a common symptom and side effect from chemotherapy and radiation treatments. It is also a symptom of anemia, which is a low red blood cell count as noted from blood tests. Or it can be caused from a B12 vitamin or iron deficiency, which your doctor may also find in a blood test. Whatever the cause, you may feel only slightly tired or you may suffer from extreme fatigue.

Your doctor will take blood samples from you for tests throughout your treatment. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss, chemotherapy, or radiation.

If your doctor tells you that you have anemia, take these actions to feel better:

• Add mild exercise, such as walking, to your daily routine.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration adds to fatigue.

• Take action to treat a poor appetite because eating improperly can make you tired.

• Take short rests when you’re tired. Avoid long naps during the day so that you can sleep well at night.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back throughout treatment.

Taking these actions may ease your mental stress:

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer “buddy” who can help you cope.

• Ask your doctor about counseling or medications for depression and anxiety.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation, which includes difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it’s wise to take these preventive actions. These same steps may also give you relief if you are already constipated:

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative only as prescribed by your doctor.

Diarrhea

This may be a side effect of chemotherapy or radiation therapy. Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration. These steps may help you avoid or at least limit diarrhea:

• Avoid or limit milk and milk products.

• Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

• Eat low-residue, low-fiber foods, such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

• Drink more fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Dry or irritated skin

This may be a side effect of radiation therapy or chemotherapy:

• Protect your skin from sun exposure by covering it up and wearing sunscreen of at least 15 SPF.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don’t use any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after radiation treatment because they may cause irritation.

• Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

• Don’t scratch, rub, or scrub treated skin. After washing, gently blot dry.

• Don’t bandage skin with tape. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don’t apply heat or cold to the treated area. Bathe only with lukewarm water.

• If you must shave the treated area, use only an electric shaver. Don’t use lotion before shaving. And don’t use hair-removal products.

• Keep your nails well trimmed and clean.

Hot flashes

Hot flashes may occur in men receiving hormone therapy. To ease them, try these tips:

• Ask your doctor about medications you can take to ease symptoms.

• Try keeping a diary to identify what actions or situations trigger a hot flash. Recognizing what causes the hot flashes may help you avoid them.

Mouth sores (mucositis)

Some types of chemotherapy may cause these. Mouth sores may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions:

• Brush your teeth after meals and before bedtime; floss every day if this is something you do regularly and you get your doctor's permission.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions:

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• Ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

• Call your doctor or nurse if your temperature reaches 100.5 degrees Fahrenheit or higher.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea:

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting occurs if you’re no longer responding to antinausea treatments.

To prevent nausea, take these actions. Most nausea can be prevented:

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed.

To help ease nausea or vomiting if you have it, try these tips:

• Try eating foods and drinking beverages that were easy to take or made you feel better when you’ve had the flu or were nauseated in the past. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists, which may help to decrease your nausea.

Neutropenia (low white blood cell levels)

Many types of chemotherapy can cause low white blood cell counts. Without enough white blood cells, your body may not be able to fight infection. If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:

• Avoid crowds or people who are sick.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Numbness, tingling, or muscle weakness in your hands or feet (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy, such as Taxotere (docetaxel) and Jevtana (cabazitaxel), are known to cause this. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, take the precautions to protect yourself:

• Take extra care walking and moving so that you don’t fall.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Sexual problems: impotence, erectile dysfunction

The inability to have an erection can be a short-term or long-term side effect of treatment for prostate cancer. Basically, all the treatments for prostate cancer carry a risk for impotence. They differ in how soon after treatment it may occur and how likely it is to occur. The psychological stress of coping with cancer can also affect your ability to have sex. Before treatment, ask your doctor what you can expect. Knowing what to expect may help you cope. Here’s an overview of treatments for prostate cancer and their risk of impotence:

• Surgery. The nerves that control erections run along either side of the prostate. These nerves may be damaged during surgery to remove the prostate. Problems with erections are most apparent right after surgery, but for some men they may get better over time.

• Radiation therapy. Radiation may damage the nerves that control erections. This damage usually occurs over time, so the effects of radiation therapy on erections tends to get worse over a year or so after treatment.

• Hormone therapy with LHRH analogues or orchiectomy. The loss of testosterone causes a loss of libido, but it’s not known why that loss affects erections. When impotence occurs, it happens soon after starting treatment.

Taking these actions may help you cope with these changes:

• Talk with your doctor about medical or surgical ways to restore erections. Your options may include medications such as Viagra (sildenafil); penile implants; injections; or vacuum devices.

• Talk with your partner about changes in your ability to have sex.

• Explore new ways to share affection and intimacy.

• See a counselor who specializes in sexual problems.

• Discuss it with your doctor and other members of your health care team. They may be able to refer you to a sexual rehabilitation program.

• If childbearing is an issue, talk with your doctor about this before your treatment. There may be ways to store sperm in a bank.

Decreased sex drive (libido)

Hormone therapy may decrease your desire to have sex. This is due to the loss of testosterone. If you’ve had your testicles removed, there is no way to restore your libido, but you can talk with your doctor about ways to improve your sexual function. Feelings of depression from having cancer or fatigue from other treatments can also have a negative impact on your sexual desires. Here are some ways you may cope:

• Talk with your partner about changes in your desire to have sex.

• Discuss it with your doctor and other members of your health care team. They may be able to refer you to a sexual rehabilitation program.

• Request a referral to a counselor who specializes in sexual problems.

Swelling

Swelling, called edema, of the legs, scrotum, and penis rarely occurs, but when it does, it is more common in those who have undergone pelvic lymph node dissection. Penile and scrotal edema is often difficult to treat. Do these things to reduce swelling in your legs:

• Ask your doctor to recommend supportive stockings.

• Raise your feet when you sit or lie down.

Trouble thinking and remembering

You may have mild problems with concentration and memory during and after hormone therapy or chemotherapy. Being tired can make this worse.

Taking these actions may help:

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

Urinary problems

Since the prostate is around the urethra, the tube that carries urine through the penis and out of the body, treating prostate cancer, especially with localized cancer, can cause problems with urination.

Types of problems that may occur

Here are some of the problems that may occur:

• Painful urination, called dysuria

• Frequency problems. You may feel like you have to urinate all the time.

• Hesitancy problems. You may not be able to start the flow of urine even when you feel like you need to go.

• Frequently urinating at night, called nocturia. You may wake up feeling like you need to urinate, but then are not able to.

• Leaking urine during a sudden increase in abdominal pressure, such as with coughing, sneezing, laughing, or picking up heavy objects. This is called stress incontinence. It results from radical prostatectomy. It may also occur after seed therapy, especially if you also had a transurethral resection of the prostate.

• Leaking urine before you can get to the bathroom, called urge incontinence. This may also occur after a radical prostatectomy, but it's not as common as stress incontinence.

• Feeling like you can't empty your bladder when you urinate or having a weak flow of urine, called overflow incontinence. This is common in men who have had external beam radiation treatment. It also sometimes occurs in men who have had a radical prostatectomy or interstitial seed therapy.

These problems can result from surgery, internal and external radiation, and cryotherapy. Sometimes they are temporary. For instance, with external radiation, urinary problems often don't start until a few weeks into the treatment. Then, they may stop several weeks after treatment has ended. Sometimes they are permanent.

Tips for coping

Not being able to control your urine can lead to anxiety, hopelessness, and loss of self-control or self-esteem. Take heart. There are treatments available. Start with these steps:

• Talk with your partner about how you feel if your fear of incontinence is limiting your participation in sex or social activities.

• Talk with your doctor about prescription drugs that may decrease urinary frequency or help with other problems.

• Keep track of your symptoms so that you can let your doctor know exactly what is happening. Record how many incontinence pads you use, what activities cause incontinence, how frequently you urinate, if you have frequency or urgency, how strong your force of urine stream is, if you feel that you are emptying your bladder well, and what types and how much fluid you are drinking.

• Make sure you urinate regularly.

• Avoid drinking caffeinated beverages because caffeine causes the kidneys to make more urine and irritates the bladder.

• It may help to avoid acidic foods, such as orange juice, and spicy foods because they may irritate the bladder.

• Talk with your doctor about how to do Kegel exercises to help with stress incontinence. These exercises strengthen the pelvic floor muscles. Here's how to identify these muscles. Try stopping your urine stream while you are urinating. The muscle you use is the one you want to strengthen. To perform Kegel exercises, simply repetitively contract and relax that muscle at least 20 times every day. These exercises may be most helpful when the catheter is removed after radical prostatectomy. They may not be as effective in men who have had radiation treatment. Not all doctors agree on how useful these exercises are or on the best way to do them.

• Talk with your doctor about your options for treatment. These may include medications, catheterization, and other options.

Weight Gain

You may gain weight if you have hormone therapy to treat prostate cancer. Take these actions to help manage your weight:

• Increase the amount of your daily exercise. Strive to be active every day.

• Eat a balanced, low-calorie diet.

• Increase the amount of fruits and vegetables you eat. And drink more water. These can help fill you up--and are good for you--without adding a lot of calories.

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