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Prostate Cancer: Managing Treatment Side Effects

Prostate Cancer: Managing Treatment Side Effects

Treatment for prostate cancer can cause side effects. The side effects vary from person to person. The side effects you may have depend on the kinds of treatment you have, your overall health, and other factors.

Side effects of prostate cancer treatment can include:

  • Anxiety or depression

  • Constipation

  • Diarrhea

  • Hot flashes

  • Erection problems (erectile dysfunction or ED)

  • Infection

  • Low sex drive (low libido)

  • Mouth sores and dryness

  • Nausea and vomiting

  • Nerve damage (peripheral neuropathy)

  • Skin irritation

  • Swelling (edema)

  • Tiredness (fatigue)

  • Trouble thinking and remembering

  • Urinary problems

  • Weight Gain

Read below to see ways to manage each of these side effects during your treatment.

Anxiety or depression

Some people may feel worried, sad, or stressed when dealing with cancer. These feelings may continue during treatment. You may also worry about how you will look after the treatment. You may have mood changes as a side effect of hormone therapy. These may be mild or serious. Seek help right away if have:

  • Frequent crying

  • Extreme sadness

  • Loss of interest in things you once enjoyed

  • Severe changes in mood

  • Thoughts of suicide

Make sure to:

  • Talk with your family or friends. Express your concerns.

  • Ask your health care team, health care team, or social worker for help. They can connect you with a support group. It can help to talk about concerns with people who have gone through the same experience.

  • Speak to a counselor. A professional therapist can help you cope with stress and other feelings.

  • Talk with your spiritual advisor. A priest, minister, or rabbi can help you during this time.

  • Ask your health care team about medicines. If depression or anxiety makes it hard to cope with daily life, your health care team may recommend medicines to help.

  • Keep active. Maintain your social activities as much as possible. Keep physically active, too. Walk, ride a bike, go to the gym.

  • Get group support. Join a cancer support group or find a cancer “buddy” who can help you cope.

Constipation

Constipation is when bowel movements are difficult or don’t happen often enough. It can range from mildly uncomfortable to painful. Some pain medicines can lead to constipation. To help prevent and relieve constipation:

  • Drink plenty of fluids water and fruit juices, such as prune juice.

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

  • Exercise regularly.

  • Take stool softeners or a laxative, if advised by your health care team.

Diarrhea

Diarrhea is when bowel movements are loose or happen too often. It may lead to dehydration. Radiation, chemotherapy, and hormone therapy can cause diarrhea. Take these steps if you have diarrhea:

  • Ask your health care team about medicines that may help.

  • Don’t eat gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

  • Don’t drink milk or eat dairy foods if they make things worse.

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

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

Hot flashes

Hot flashes may occur in men who have hormone therapy. To ease hot flashes:

  • Keep a log of what kinds of things trigger your hot flashes. This may help you prevent them.

  • Ask your health care provider about medicines you can take to ease symptoms.

Erection problems (erectile dysfunction or ED)

The inability to have an erection can be a short-term or long-term side effect of treatment for prostate cancer. All treatments for prostate cancer have a risk for ED. They differ in how soon after treatment it may occur and how likely it is to occur. The stress of coping with cancer can also affect your ability to have sex. Before treatment, ask your health care provider 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 ED:

  • 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. 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 tend 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 ED occurs, it happens soon after starting treatment.

Taking these actions may help you cope with these changes:

  • Talk with your health care provider about ways to restore erections. Your options may include medicine such as sildenafil, a penile implant, injections, or a vacuum device.

  • 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.

  • If having children is an issue for you, talk with your health care provider about this before your treatment. There may be ways to store sperm in a sperm bank.

Infection

Chemotherapy and radiation therapy can cause low white blood cell counts. This is called neutropenia. Without enough white blood cells, your body may not be able to fight infection. You may have symptoms of infection, such as fever, chills, or inflammation at the site of an injury.

During your treatment, your health care team will take samples of your blood for testing. If your health care team tells you that your white blood cell count is low, take these actions to stay healthy:

  • Ask your health care team if you need to take antibiotics to help prevent infections.

  • Avoid crowds and people with colds.

  • Avoid fresh flowers and plants, which can carry mold.

  • Don’t eat fresh, unwashed, uncooked fruits and vegetables and other foods that might carry germs. Wash and peel raw produce before eating it.

  • Wash your hands often during the day to kill germs. Have people around you do the same. Bathe daily. This is to help to keep the amount of bacteria on your skin lower. Don't touch your eyes or nose unless you've just washed your hands.

  • Call your health care team right away if you have any signs of infection. Signs may include a temperature of 100.5° (38°C) or higher, chills, a cough or hoarseness, lower back or side pain, painful or difficult urination, or any sores or redness.

Low sex drive (low libido)

Hormone therapy may decrease your desire to have sex. This is due to the loss of testosterone. This can’t be treated by replacing testosterone because the lowering testosterone is the treatment for prostate cancer. If you’ve had your testicles removed, there is no way to restore sex drive, but you can talk with your health care provider about ways to improve your sexual function. Depression or tiredness can also affect your sex drive. Here are some things you can do:

  • Talk with your health care team. They may be able to refer you to a counselor who specializes in sexual issues.

  • Talk with your partner. Be open about the changes in your desire or ability to have sex. Explore new ways to share affection and intimacy.

Mouth sores and dryness

Radiation and some types of chemotherapy can cause mouth and lip sores. These sores are called mucositis. They may hurt and make eating difficult. Radiation to your chest or neck may also cause dry mouth called xerostomia. To ease these problems:

  • Brush your teeth after meals and before bedtime. Floss every day if your health care team says it's OK to do so.

  • Rinse your mouth with lukewarm water with salt or baking soda several times a day.

  • Keep your mouth clean and moist. Use lip balm to keep your lips moist.

  • Suck on sugar-free candies or chew sugar-free gum to help increase moisture in your mouth.

To ease the pain if you get sores in your mouth:

  • Ask your health care team about topical mouth medicines.

  • Don’t use mouthwash that contains alcohol. It may irritate the sores.

  • Don’t eat hot, rough, or spicy foods. These may irritate the sores.

  • Don’t use tobacco. It may irritate sores, or make you more to get sores.

  • Eat soft and pureed foods that are easy to swallow if you have a dry mouth.

  • Sip water often.

  • Take over-the-counter pain medicine, such as acetaminophen, if needed.

  • Call your health care team if you have a fever of 100.5° (38°C) or higher.

Nausea and vomiting

Nausea and vomiting may result from almost all types of treatment for kidney cancer. It may be very mild to severe. Understanding the different types of nausea may help. The types include:

  • Acute-onset nausea and vomiting. This occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment. The symptoms end within the first 24 hours. Immunotherapy with interleukin-2 (IL-2) tends to cause nausea during the whole treatment. Nausea gets worse at the end of the cycle.

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

  • Anticipatory nausea and vomiting. These 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 before. This can trigger the actual symptoms.

  • Breakthrough vomiting. This is vomiting that occurs despite treatment to prevent it. It requires other types of treatment.

To help prevent nausea:

  • Ask your health care team about taking a prescription medicine to control nausea and vomiting. Make sure you take it as directed. If you are vomiting and cannot take medicine, call your health care team.

  • If you have nausea and vomiting while taking anti-nausea medicine, call your health care team. They can change your medicine, or add other medicines.

To help ease nausea or vomiting:

  • Ask your health care team about using acupressure bands on your wrists. These may help to decrease your nausea.

  • Ask your health care team to help you learn a relaxation exercise. This may make you feel less anxious and more in control, and can decrease your nausea.

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

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

  • Take medicines with food, as directed.

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

Nerve damage (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 docetaxel and cabazitaxel, are known to cause this. Other signs of this problem are ringing in your ears or feeling too hot or cold. Nerve damage can make you more at risk for injury

If you have these symptoms, you’ll need to take care to protect yourself from injury:

  • Clear your home of clutter. Put away throw rugs so that you don’t trip or fall.

  • Take extra care when walking and moving so that you don't fall. Less sensitivity in your feet can alter your balance.

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

  • Use warm, not hot, water for bathing. This is to prevent burns. Use a shower chair or railing to reduce your chance of slipping in the tub.

  • If your daily activities are too difficult, ask your health care team to refer you to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so you can stay as active as possible.

Skin irritation

Radiation treatment can cause dry or red skin in the area being treated. Also, you may have dryness, itching, or a rash in the area of biological therapy injections. Here’s what you can do for relief:

  • Wear loose, soft clothing over the treated area.

  • Don't scratch, rub, or scrub treated skin. Wash gently, and blot dry gently.

  • Only use paper tape if you apply a dressing to the area. Ask your health care team to help you place the dressing so that you can prevent more irritation.

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

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

  • Keep your nails well-trimmed and clean so that you don't damage sensitive skin when you touch it.

  • Protect your skin from the sun. Cover the treated area and wear sunscreen with at least SPF 30.

  • Ask your health care provider what kind of lotion is best to soothe your skin.

  • Ask your health care provider if soap, deodorant, sunscreen, perfume, cosmetics, or powder is safe to use on your skin.

  • Use topical ointments and steroid creams for itchy skin rashes, if prescribed.

Swelling (edema)

Swelling (edema) of the legs, scrotum, and penis is rare. It’s more common in men who have had a lot of pelvic lymph nodes removed, or had radiation therapy in the pelvic area. It can also be caused by some chemotherapy medicines, such as docetaxel. Or it can be caused by the cancer itself if it is advanced or has spread to the lymph nodes. Penile and scrotal edema is often difficult to treat. Swelling in the legs can be helped by wearing compression socks or stockings, and keeping your feet raised when you sit or lie down.

Tiredness (fatigue)

Tiredness is a very common side effect. It can be a result of anemia caused by low red blood cell levels. Red blood cells carry oxygen around the body. Decreased red blood cell counts can be caused by blood loss, chemotherapy, hormone therapy, radiation, or the cancer itself. Other things can cause fatigue, such as a vitamin B12 deficiency, dehydration, or not eating enough. Tiredness can last several weeks after treatment ends. You may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy levels:

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

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

  • Drink plenty of fluids to prevent dehydration.

  • If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy. These can include grocery shopping or housework. You may also need to reduce your hours at work.

  • Take action to treat a poor appetite.

  • Take short rests when you feel tired. Don’t take long naps during the day. These can disrupt nighttime sleep.

  • Talk with your health care team about your fatigue and what be causing it. Some medicines or treatments may help.

Trouble thinking and remembering

Chemotherapy and hormone therapy can cause mild problems with thinking and memory. Fatigue can worsen the problem. Taking these actions can help:

  • Make lists.

  • Write down important information you need to remember.

  • Use other tools to help organize your life. These tools may include calendars, pill dispensers, or alarm clocks.

  • Tell your medical team about any cognitive changes. Your team can assess any cognitive concerns and suggest treatments that can help you and your family manage the changes. 

Urinary problems

The prostate gland sits around the urethra, the tube that carries urine through the penis and out of the body. Because of this, prostate cancer and its treatments can cause problems with urination.

Problems can include:

  • Painful urination (dysuria)

  • Feeling like you need to urinate all the time

  • Having trouble starting the flow of urine when you need to go

  • Need to urinate often at night (nocturia)

  • Leaking urine during a with coughing, sneezing, laughing, or picking up heavy objects (stress incontinence)

  • Leaking urine before you can get to the bathroom (urge incontinence)

  • Feeling like you can't empty your bladder, or having a weak flow of urine (overflow incontinence)

These problems can result from surgery, radiation, and cryotherapy. Some of these problems are temporary and may stop several weeks after treatment has ended. Some problems may be permanent.

Some things you can do to help:

  • Keep track of your symptoms so that you can let your health care provider know exactly what is happening. 

  • Talk with your health care provider about your options for treatment. These may include medicines, catheterization, and other options.

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

  • Don’t drink caffeinated beverages. Caffeine causes the kidneys to make more urine and irritates the bladder.

  • Don’t eat or drink acidic food or drinks, such as orange juice or tomatoes. Don’t eat spicy foods. These things may irritate the bladder.

  • Talk with your health care provider about how to do Kegel exercises. These can help with stress incontinence.

Weight gain

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

  • Increase the amount of your daily exercise. Be active every day.

  • Eat a healthy lower-calorie diet.

  • Eat more fruits and vegetables and drink more water. These can help fill you up in a healthy way without adding a lot of calories.

Talking with your health care team

Getting treatment for cancer can be tough on the mind and body. Keep talking with your health care team about ways to make the process easier. Work together to ease the affect of symptoms on your daily life.

 
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