Managing side effects of prostate cancer treatments
You will be given regular appointments to monitor your PSA levels following treatment. Your treatment team or your GP will also ask how well you are feeling and if you have any symptoms. How often you are seen will get less over time depending on your PSA results.
Your PSA level should drop to very low or be undetectable following surgery. To limit your anxiety, ask your treatment team what changes in PSA level they would be concerned about.
PSA levels following radiation tend to drop slowly and may not reach their lowest level until two or more years later.
PSA monitoring during treatment for advanced prostate cancer can help show how well the treatment is working.
“I had prostate cancer and had a radical prostatectomy. My PSA was zero but there was 3-4 years where I didn’t have my levels tested. Now my levels have gone up again and I don’t know why I wasn’t tested earlier.”
Following treatment you may experience a number of side-effects. These include incontinence, changes in your sex life and your fertility, bowel changes and hormonal changes. This section talks about ways to help manage these.
Incontinence refers to the leaking of urine. The amount of urine leaking can vary. For the majority of men it is temporary, and should resolve within a year.
A small number of men continue to have significant incontinence on a long-term basis. If incontinence is worrying you, talk to your specialist about having an assessment. There are options available to treat or better manage your incontinence.
Wearing pads or absorbent underwear
Wearing pads or absorbent underwear will help. Ask your GP for a referral to the continence services at your local DHB for help with the supply of the most appropriate product for your leakage.
Urinary sheaths, bed protectors and hand-held urinals may be available through your continence service.
Pelvic floor exercises
Regular pelvic floor exercises, which involve exercising the muscles of the pelvic floor, help many men to regain bladder control after prostate surgery. It is best to start these exercises before treatment as normal pelvic floor muscle sensations may be altered for several weeks afterwards. Ask your treatment team for information about pelvic floor exercises.
It is normal to have stress incontinence (urinary leakage associated with movement and activity) after your catheter is removed after surgery. This may persist for many months but usually improves over time.
Specialist continence nurses can help with advice and equipment. A small number of men may need further support if incontinence persists or worsens. Most urology departments have pelvic floor physiotherapists. Ask for a referral, ideally before surgery.
For more information on continence and pelvic floor exercises, see Continence NZ’s website, www.continence.org.nz.
Fatigue is often confused with tiredness. Usually you know why you are tired and a good night’s sleep solves the problem.
Fatigue is overwhelming tiredness (physical and emotional) and is not relieved by rest or sleep. Cancer-related fatigue is one of the most common side-effects of cancer and its treatment. It can happen to anyone with any type of cancer and at any time, during and after treatment. Gentle exercise can help to relieve fatigue.
For more information on fatigue and suggestions on how to manage it, see the Cancer Society’s information sheet Cancer-related fatigue on our website, www.cancernz.org.nz.
Having prostate cancer can cause worry, stress and sadness, making it seem an effort to keep active and connect with family/whānau and friends. This can lead to isolation and may make it harder to manage the effects of treatment. Some treatments for prostate cancer, such as hormone treatments, can put men at a greater risk of experiencing mood changes, anxiety and depression.
“My wife was a trained nurse but even she found coping with my post-surgery depression extremely difficult. The nature of the disease meant I was self-focused and spent little or no time considering the emotional needs of loved ones.”
Two key signs of depression are constantly feeling down or hopeless, and having little pleasure in doing the things you used to enjoy (www.depression.org.nz; retrieved 10/4/19).
Remember that your mental health is as important as your physical health. If you are concerned about yourself or someone else, talk to your GP or treatment team. There’s a lot that can be done that can make a difference.
Me maumahara, he rite te hira o tō hauora hinengaro ki tō hauora tinana. Mehemea kai te māharahara koe mōu ake, mō tētahi atu rānei, me kōrero ki tō GP, ki tō rōpū maimoa rānei. He nui tonu ngā āhuatanga ka taea te whakamahi, e puta ai te rerekētanga.
Mindfulness programmes, relaxation, meditation and exercise are all helpful things to try when you are feeling low. Talk to a trained counsellor about how you are feeling. Contact the Depression Helpline on 0800 111 757.
“Support from my wife, family and friends helped me cope. And exercise helped the mind.”
“When I was on hormone therapy I didn’t know what the side-effects would be or how to deal with them. I put on a lot of weight and felt like crying for no reason, and then you get to the things nobody talks about like my penis shrinking and loss of sex drive.” Matt
Hormone treatment can cause a range of side-effects that change the quality of men’s lives. These include hot flushes, weight gain and breast swelling.
Some men find their hot flushes reduce as their bodies become used to the treatment, while others may have ongoing problems. You can help manage these by:
- keeping to a healthy weight
- stopping smoking if you smoke
- drinking plenty of fluids and limiting alcohol and caffeine
- reducing the amount of spicy food you eat
- keeping your room at a cool temperature and using a fan
- using cotton rather than synthetics. If you sweat a lot at night, try using a cotton towel on top of your sheet when you sleep
- having lukewarm baths or showers
- talking to your GP about any medications that might relieve symptoms.
Some men have found that acupuncture or hypnotherapy helps.
Resistance exercise, such as lifting weights, can help with muscle strength, while regular walking can keep your weight stable and also help with muscle strength. Eating in a healthy and balanced way will also help with weight management. The Ministry of Health recommends
Sit less, move more! Break up long periods of sitting.
Do at least 2½ hours of moderate or 1¼ hours of vigorous physical activity spread throughout the week.
For extra health benefits, aim for 5 hours of moderate or 2½ hours of vigorous physical activity spread throughout the week.
Doing some physical activity is better than doing none.
(Retrieved from www.minhealth.govt.nz)
Men on hormone therapy should discuss ways to preserve their bone density with their treatment teams. Bone-strengthening medication may be suggested, and regular exercise that increases your heart rate and builds muscle strength can be helpful.
Men on anti-androgen therapy who are at risk of osteoporosis should try to include calcium in their diets. Good sources of calcium include:
- dairy products
- green vegetables
- tinned sardines with the bones
- whole grain foods, such as bread, rice and cereals.
Some hormonal treatments cause breast swelling or tenderness. If this causes discomfort, talk to your treatment team about the options that might help to reduce the side-effects. Some men get benefits from a single dose of radiation treatment to the breast area. This usually works best if given before hormone treatment starts. Sometimes low-dose tamoxifen is used to help with this side-effect.