Prostate Cancer 

Side Effects

The side effects that accompany prostate cancer treatment are often a source of great concern. Though most cancer treatments have side effects, you likely won’t have all of them. Every person responds differently, even to the same type of treatment. As you discuss potential therapies, ask your doctor about the possible physical, sexual and/or emotional side effects of each so you can set your expectations accordingly (see Table 1, Common Physical Side Effects of Prostate Cancer Treatment).

Incontinence

Difficulty with urination may happen after treatment for prostate cancer with surgery or radiation therapy. Incontinence, or leakage of urine, can range from mild to severe. There are three types of incontinence.

  • Stress incontinence, the most common type following prostate surgery, 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 the urine. You may get up often during the night to go to the bathroom, take a long time to urinate or have a weak, dribbling stream with little force. In addition, you may pass small amounts of urine but not feel as though the bladder is empty, or you may feel like you need to go to the bathroom but cannot. Urine may leak throughout the day. 
  • Urge incontinence is the most common type after radiation therapy and the 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. Daytime or nighttime accidents may occur.

There are ways to manage incontinence. The goal is to continue with your daily life with little disruption. Be open about your symptoms. Your honesty will help your doctor find the best ways to make you more comfortable, which may include the following:

  • Pelvic floor exercises, commonly known as Kegels (pronounced KEE-gulz), can help reduce leakage from stress incontinence (see About Kegel exercises, page 13).
  • Medications that will tighten or relax your muscles may be prescribed. These drugs can have side effects, so make sure to ask about them. 
  • For overflow incontinence caused by blockage of the urethra by scar tissue or by an enlarged prostate, a surgical procedure done through a scope can relieve the obstruction.
  • In serious cases of stress incontinence, the surgeon may implant a sling to hold up the bladder or place an artificial urinary sphincter (device that constricts) around the urethra to prevent or reduce leakage.
  • As temporary measures, catheters and compression devices to collect urine or stop leakage, such as a condom catheter (which fits over the penis and drains urine into a storage bag), a penile clamp (which stops leakage with a v-shaped foam cushion that presses on the urethra) or a small urethral plug, are options.

Erectile Dysfunction

Also called impotence, erectile dysfunction (ED) is one of the most common side effects of prostate cancer treatment, and it may be one of the most feared. 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.

Regaining erectile function is possible, but it typically takes time for full recovery after surgery. After radiation therapy, erections are not affected immediately, but may begin to fail over time, worsening year by year for three to five years. Three to five years after either prostatectomy or radiation, approximately the same percentage of men have erectile dysfunction. Men age 60 and under, when treated, recover or retain erections more readily than older men.

As you and your doctor discuss potential treatments, ask which ones may cause ED, if it will be temporary or permanent, and how to manage it. If you are having surgery, ask if a nerve-sparing approach that improves the chances of recovering erections is an option.

Some men regain their ability to have erections naturally, whereas others need medical help to correct the issue.

To manage your ED, your doctor may recommend one or more of the following:

  • Oral medications may help you achieve and maintain an erection. These must be used with care if you take nitrates or alpha- blockers for high blood pressure, heart disease or urinary control. 
  • Penile injections are an option if oral medications are ineffective or if you cannot tolerate them. Drugs may be self-injected into the erectile tissues of the penis to increase blood flow, resulting in an erection that lasts about 30 minutes. 
  • Urethral suppositories involve a special applicator to insert a suppository into your urethra inside the penis. The erection begins within about 10 minutes and may last between 30 and 60 minutes.
  • A vacuum constriction device is a small pump that is placed over the penis to increase blood flow and create an erection. 
  • A penile prosthesis or implant put in place with a surgical procedure may help restore firmness when no other treatments work.

Fatigue

People with advanced cancer often experience fatigue, a type of tiredness related to cancer and its treatment that is different from the fatigue that healthy individuals occasionally feel. It usually lasts longer, is more severe and is unrelieved by sleep. Talk to your doctor if fatigue affects your daily life. These suggestions may help. 

  • Get enough sleep. Sleep 7 to 8 hours a night. Take naps during the day, but limit them to no more than 45 minutes each.
  • Maintain good nutrition. Eat a well-balanced diet of fruits, vegetables, protein and water to help promote healing and restore your energy. 
  • Be active. Exercise, even a short walk, relieves fatigue. Balance your activity with rest. Save your strength for activities that are most important. 
  • Consider alternative therapies. Massage, acupuncture and acupressure may help you relax.

Emotional Well-Being

Prostate cancer treatment can affect your mental health in many ways. These feelings are normal, and it is important to acknowledge and address them. They may include any of the following: 

  • Loss of identity. Many men associate masculinity with sexual performance. If that ability is impaired, they may feel shame, frustration or depression. 
  • Feeling out of control. A change in sexual abilities and bowel or bladder control can be upsetting. Tell your health care team as soon as you experience problems. They are skilled in helping you manage these side effects.
  • A lack of desire. Your interest in sex may be low due to hormone changes. Be honest with your partner. You may explore ways to be intimate other than the physical relationship you are used to. 
  • Financial stress. Talk with the financial representative at your cancer center, and contact your insurance company to find out your coverage. 
  • Depression. Contact your doctor about excessive crying or continued feelings of hopelessness or despair. Get immediate medical attention for thoughts of suicide or death.

Support is available from many sources, such as in-person and virtual (online) prostate cancer survivor groups. Some organizations are men only, others offer buddy programs that pair you with another prostate cancer survivor. In addition, telephone and email cancer helplines are available.

Consider talking with a therapist who has experience counseling cancer survivors.

Lastly, keep in mind that your diagnosis also affects your loved ones. Your partner and other family members could be a source of comfort.

Table 1. Common Physical Side Effects of Prostate Cancer Treatment

Side Effects Symptoms
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
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 Stomach upset that may be prevented by antiemetic (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: Exercises to help manage incontinence

Kegel exercises are helpful before and after prostate surgery. With consistent practice, you could strengthen your muscles and see a marked improvement in just weeks depending on your goal. Your goal may be to manage stress urinary incontinence, which is leakage that occurs during moments of physical activity or when you sneeze, cough, laugh, etc. Or you may be trying to manage leakage that happens when you have a sudden urge to urinate and have not yet reached the bathroom.

Your doctor or a pelvic health therapist can work with you to ensure you are using the correct muscles for what you are trying to achieve. And, you should not practice Kegels if you have a catheter in your penis.

To get started, try to perform these exercises while you are standing. If you are not able to, try sitting or choose a position that is comfortable for you.

  1. Tighten your pelvic floor muscles. Ensure you’re flexing the correct muscles (not your abdomen, thighs or buttocks). Tighten the muscles used to stop urinating mid-flow.
  2. Hold the contraction for 10 seconds, and then relax for 10 seconds. Breathe freely during the exercises.
  3. Aim for at least six sets of 10 repetitions a day. As your muscles get stronger, increase your repetitions daily.
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