Treatment Update: Prostate Cancer

All cancer treatments can cause side effects. It’s important that you report any side effects that you experience to your health care team so they can help you manage them. Report them right away— don’t wait for your next appointment. Doing so will improve your quality of life and allow you to stick with your treatment plan. It’s important to remember that not all people experience all side effects, and people may experience side effects not listed here.

Side Effects of Hormonal Therapy

The side effects of hormonal therapy in the treatment of prostate cancer can include mild anemia, fatigue, changes in cholesterol, mood changes, loss of sexual thoughts and erectile dysfunction. There is also an increased risk of cardiovascular events in men with pre-existing risk factors, such as high cholesterol or prior heart attacks.

Additional potential side effects:

• Hot flushes. There are medications that can help if hot flushes occur, such as certain types of antidepressants or low doses of female hormones (estrogen or progesterone), given orally or via a patch.

• Osteoporosis (increased risk of bone fractures). Lowered testosterone levels lead to a loss of calcium, which may cause osteoporosis (thinning, brittle bones). Treatment with bisphosphonates can help reverse the effects of osteoporosis.

• Weight gain. Some prostate cancer treatments can cause fluid retention, weight gain and a loss of muscle mass. During treatment, men should stay as active as possible.

Side Effects of Radiation Therapy

Changes to the skin are the most common side effects of radiation therapy. The changes can include dryness, swelling, peeling, redness and blistering. It’s especially important to contact your health care team if there is any open skin or painful areas, as this could indicate an infection. Infections can be treated with an oral antibiotic or topical antibiotic cream.

Radiation can also cause mild urinary burning, burning in the rectum or a change in stool habits. Your health care team can recommend approaches to alleviate the discomfort of these side effects should they occur.

Side Effects of Chemotherapy

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are used, and can include:

• Achiness
• Hair loss
• Increased risk of infection (from having too few white blood cells)
• Easy bruising or bleeding
• Changes in memory or thinking
• Peripheral neuropathy (numbness or tingling in hands and feet)

Some side effects may occur across treatment approaches. This section provides tips and guidance on how to manage these side effects should they occur.

Managing Digestive Tract Symptoms

Nausea and vomiting

• Avoid food with strong odors as well as overly sweet, greasy, fried or highly seasoned food.
• Eat meals cold or at room temperature, which often makes food more easily tolerated.
• Nibble on dry crackers or toast. These bland foods are easy on the stomach.
• Having something in your stomach when you take medication may help ease nausea.

Diarrhea

• Drink plenty of water. Ask your doctor about using drinks such as Gatorade that provide electrolytes. Electrolytes are body salts that must stay in balance for cells to work properly.
• Over-the-counter medicines such as loperamide (Imodium A-D and others) and prescription medications are available for diarrhea but should be used only if necessary. If the diarrhea is bad enough that you need medicine, contact a member of your health care team.
• The BRAT diet (bananas, rice, applesauce, toast) and soluble fiber such as oats, bran and barley can help with diarrhea. Foods high in insoluble fiber, such as leafy greens and most fruits should be avoided as they can worsen diarrhea. Oily foods should also be avoided.
• Avoid foods high in refined sugar and those sweetened with sugar alcohols such as sorbitol and mannitol.

Loss of appetite

• Eating small meals throughout the day is an easy way to take in more protein and calories, which will help maintain your weight. Try to include protein in every meal.
• To keep from feeling full early, avoid liquids with meals or take only small sips (unless you need liquids to help swallow). Drink most of your liquids between meals.
• Keep high-calorie, high-protein snacks on hand such as hard-boiled eggs, peanut butter, cheese, ice cream, granola bars, liquid nutritional supplements, puddings, nuts, canned tuna or trail mix.
• If you are struggling to maintain your appetite, talk to your health care team about whether appetite-building medication could be right for you.

Managing Fatigue

Fatigue (extreme tiredness not helped by sleep) is one of the most common side effects of many cancer treatments. If you are taking a medication, your doctor may lower the dose of the drug, as long as it does not make the treatment less effective. If you are experiencing fatigue, talk to your doctor about whether taking a smaller dose is right for you.

There are a number of other tips for reducing fatigue:

• Take several short naps or breaks during the day.
• Take walks or do some light exercise, if possible.
• Try easier or shorter versions of the activities you enjoy.
• Ask your family or friends to help you with tasks you find difficult or tiring.

There are also prescription medications that may help, such as modafinil. Your health care team can provide guidance on whether medication is the right approach for your individual circumstances.

Managing Pain

There are a number of options for pain relief, including prescription and over-the-counter medications. It’s important to talk to a member of your health care team before taking any over-the-counter medication to determine if it is safe and to make sure it will not interfere with your treatment. Many pain medications can lead to constipation, which may make your pain worse. Your doctor can prescribe medications that help to avoid constipation.

Physical therapy, acupuncture and massage may also be of help in managing your pain. Consult with a member of your health care team before beginning any of these activities.

Q: I was just diagnosed with prostate cancer. What questions should I ask the oncologist about the recommended treatment approach?

A: Here are some questions you should ask; others will likely arise in the course of your discussion.

• What are the goals of treatment?
• How long will treatment last?
• Do you have any written information about this treatment?
• What are the side effects of this treatment?
• Are there any ways to help manage side effects?
• How do I know if a side effect is severe enough to call you?
• Are there any other treatment options?
• Will treatment need to be given at a center that specializes in prostate cancer?
• Are there any clinical trials I should be aware of?
• What is the best way to let you know when I have questions about treatment?

Q: I’ve just been diagnosed with prostate cancer and have been told I am at low risk for developing an aggressive form of the disease. Are there any tests available to confirm that?

A: There are genetic tests available for this purpose; they include Oncotype DX, Decipher, Prolaris and ProMark. These tests can identify which men are truly at low-risk (and can be managed through active surveillance) and which men should seek immediate treatment. Your doctor can provide additional information should you wish to pursue this testing.

Q: My brother has prostate cancer. I want to help with caregiving, but I live far away. What can I do?

A: Even from a distance, you can provide ongoing emotional support to your brother and to his primary caregiver. It is sometimes easier for people to talk about difficult topics over the phone than in person, so be willing to have in-depth and serious conversations. You can also help coordinate medical appointments (and send reminders to your brother and his caregiver about those appointments), provide verbal updates to other family members, and share information on how your brother is feeling (if he agrees) in an on-line journal such as CaringBridge.