Prostate cancer that spreads beyond the prostate gland is considered advanced. When your cancer is at this stage, it's more likely to cause complications such as pain, erection problems, and incontinence.

In addition to the cancer itself, the medicines, surgery, or radiation you may get to treat it may cause side effects.

You can take steps to manage many of the complications or side effects that might arise. Here’s what you need to watch for.

Fatigue

Prostate cancer, or treatments like hormone therapy, radiation, and chemotherapy, can make you feel tired. Treatment can also result in low red blood cell counts, which may affect your energy levels.

To keep your energy up and boost your immune system:

  • Follow a healthy diet that includes plenty of fruits and vegetables. See a dietitian if you have trouble eating enough.
  • Exercise, every day if you can. Even when you're feeling bad, try to move a little.
  • Get enough rest. Schedule some downtime into your day whenever possible.
  • Tell your doctor. They can recommend ways to manage fatigue, and check for any other health issues that might contribute to it.

Erectile Dysfunction (ED)

Prostate cancer or its treatments -- or even the stress of dealing with cancer -- can make it difficult to get or keep an erection. This condition is called erectile dysfunction (ED).

Cancer can damage the nerves around your prostate, which help control erections. Surgery, radiation, or hormone therapy can also harm nerves in the area or reduce blood flow to your penis.

Some medicines and other treatments can help with ED:

  • Pills such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)
  • Medicines you inject into your penis
  • Vacuum pumps, which use suction to draw blood into your penis
  • Penile implants, which a surgeon places inside your penis

Urinary Incontinence

Prostate cancer surgery or other treatments may make it hard for you to control your bladder. Damage to nerves and muscles may cause you to leak pee or have trouble controlling its flow.

Some treatments, products, and lifestyle changes can help:

  • Absorbent pads to catch leaks
  • Medicines that work on the nerves and muscles around your bladder
  • Exercises called Kegels to strengthen bladder muscles
  • Regular trips to the bathroom, even when you don't think  you need to go
  • Avoiding caffeine, alcohol, artificial sweeteners, and other foods and drink ingredients that can irritate your bladder
  • An electrical stimulation device to make your bladder muscles stronger
  • Surgery

Pain

Advanced prostate cancer can lead to several types of pain. When it spreads to your bones, you might have bone pain, which often feels like a dull ache. Your tumor may press on a nerve, which could cause a stabbing or burning feeling.

Talk to your doctor if you're in pain. Some things that can help include:

  • Treatments for your cancer itself
  • Pain-relieving drugs
  • Other pain treatments like radiotherapy, transcutaneous electrical nerve stimulation (TENS), or a nerve block
  • Emotional support
  • Gentle exercise

Your doctor may refer you to a palliative care specialist, who can treat pain and other symptoms that arise from cancer.

Weak Bones

The most common place where prostate cancer spreads is to your bones. In addition to causing pain, this can make them become weak. Hormone therapy can also weaken your bones because it lowers testosterone levels. And weaker bones raise your risk of fractures.

Some medicines and treatments can help with complications from prostate cancer that has spread to your bones:

  • Bisphosphonates are drugs that strengthen bones. One of them is denosumab (Xgeva), which can ease pain and delay complications from tumor spread.
  • Radiation therapy may reduce pain and lower your odds of breaking a bone.
  • Radium-223 (Xofigo) is a radioactive drug that eases symptoms of cancer in the bones.
  • Chemotherapy can help with bone pain. 

To lower the chance of weak bones resulting from hormone therapy:

  • Get a bone mineral density test when you begin the therapy and every year or two afterward.
  • Exercise to keep your bones strong.
  • Take Vitamin D and calcium supplements to protect your bones.

Eating and Digestion Problems

Treatments such as radiation, chemotherapy, hormone therapy, or surgery can make it hard to eat or digest food normally. You may feel nauseated, throw up, or have loose stools or diarrhea.

You can:

  • Take anti-nausea medications recommended by your doctor.
  • Drink lots of liquids.
  • Eat several small meals each day instead of a few big ones.
  • Avoid foods that make you queasy or irritate your tummy, like caffeine, spicy foods, very sweet foods, and fried or greasy foods.

Infertility

You might be unable to father a child through sex after certain prostate cancer treatments. They include:

  • Surgery to remove your prostate gland
  • Radiation to your pelvis
  • Chemotherapy
  • Hormone therapy that lowers your testosterone levels 

If you want to have children in the future, talk to your doctor. You may be able to: 

  • Bank your sperm before treatment to freeze and use later.
  • Extract sperm from your testicles to fertilize an egg now.

Get Checked Regularly

Don't forget to schedule regular doctor visits and tests while you're going through prostate cancer treatment. Tell your doctor right away if you have alarming symptoms such as blood in your pee or bone pain. And ask your cancer-care team what symptoms or complications you should watch for.

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SOURCES:

Prostate Cancer Foundation: “Prostate Cancer Side Effects.”

American Urological Association: “What Is Advanced Prostate Cancer?”

American Academy of Family Physicians: “Neurologic Complications of Prostate Cancer.”

Mayo Clinic: “Erectile Dysfunction: Viagra and Other Oral Medications.”

Cleveland Clinic: “Nausea and Vomiting.”

Cancer.net/American Society of Clinical Oncology: “8 Ways to Cope with Cancer-Related Fatigue.”

Prostate Cancer UK: "Advanced prostate cancer: Managing symptoms."

American Cancer Society: "Managing Nausea and Vomiting at Home."