Advanced Prostate Cancer: Coping With Side Effects

Many men who have advanced prostate cancer experience side effects. Some of these side effects result from the treatments used to slow the spread of cancer. Other side effects come from the disease itself. Understanding these side effects can relieve fears and help you cope better. So can being an active participant in your own care. Ask your doctor questions. Learn about potential symptoms and options before receiving treatments. Carefully weigh each option with your doctor's input. "It's about partnering in the decision-making process," says Nancy Dawson, MD, international prostate cancer expert, professor of medicine, and director of genito-urinary medical oncology at the University of Maryland Greenebaum Cancer Center.

Impotence

Impotence -- the inability to achieve or maintain an erection -- is a major side effect of some treatments for advanced prostate cancer. Among men who have their testicles removed in a surgery called orchiectomy, about 90% experience impotence. Drugs to reduce testosterone levels, called hormonal therapy, also causes impotence in many patients. Some men who become impotent can regain erections over time, with no assistance. Other men seek treatment. Options range from devices worn externally, medicines taken orally or injected into the penis, and penis implants. Discuss these options with your doctor before you have treatment that may result in impotence.

Incontinence

Incontinence -- the inability to control urine flow -- is a common side effect of prostate cancer surgery. But most patients do eventually regain urinary control. Exercises to strengthen the sphincter and surrounding pelvic muscles can help you regain urinary control. These are called Kegel exercises. A training program called biofeedback helps reinforce the proper performance of Kegel exercises. Medications may also help relieve incontinence. Ask your doctor about these options.

Infertility

Many treatments for prostate cancer cause infertility. Several techniques can help preserve fertility, but they must be done before cancer treatment. If you want to preserve your fertility, tell your doctor before undergoing any treatment for prostate cancer.

Pain and Weakening of Bones

Prostate cancer most commonly spreads to the bones. This is called bone metastases. This condition can cause pain. It can also weaken bones and make them prone to fractures. So too can the hormone therapy that's often used to fight the spread of prostate cancer. But doctors can offer treatments to relieve bone pain and support weakened bones.

Bisphosphonates

These drugs help reduce or delay problems such as such as fractures caused by bone metastases. Researchers are also exploring the possibility of using a new bisphosphonate, Zometa, to prevent the development and progression of bone metastases in prostate cancer.

Radiation Therapy

Radiation is given to reduce bone pain in advanced prostate cancer.

• External beam radiation therapy: Radiation using a high-energy X-ray machine directs radiation to the prostate tumor. Doctors believe this form of radiation therapy is particularly helpful for patients who have lesions that don't pose an immediate risk of fracture, or when lesions are limited to a single area.
• Radioisotopes: Radiation therapy that's delivered through an injection. It targets and attacks the area of bone containing cancer. Strontium 89 is a commonly used radioisotope.

Surgery

Doctors may recommend surgery to stabilize a weakened bone or bones. A surgeon may insert rods, plates, screws, wires, or other devices to provide support to bones damaged by metastasis.

Lifestyle changes

Specific lifestyle changes can also help maintain bone health. They include decreasing alcohol intake, quitting smoking, doing regular weight-bearing exercises, and taking Vitamin D and calcium supplements.