Understanding The Side Effects of Prostate Cancer Treatment
- Treating prostate cancer involves not only addressing the disease itself but also managing the potential side effects that come with each treatment option.
- Some common side effects associated with prostate cancer treatment, like those that affect sexual function and urinary control, can be uncomfortable to talk about and seek treatment for.
- Treatment options for prostate cancer might include radical prostatectomy (surgery to remove the prostate gland), radiation therapy, and hormone therapy — and each approach has a unique side effect profile.
- While side effects can be uncomfortable and patients may even feel ashamed or embarrassed, many are temporary and there are interventions your medical team can prescribe to help deal with them.
However, open and honest conversations with your medical team, and possibly seeking second opinions, can help ensure the best possible outcome — in terms of cancer control, quality of life, and comfortably managing side effects.
Read MoreUnderstanding Potential Side Effects
Depending on the stage and risk level, treatment options for prostate cancer might include radical prostatectomy, radiation therapy, hormone therapy, and others. While each of these treatment strategies aims to control or eliminate the cancer, it is important to understand that they come with potential side effects that vary based on the treatment type and the individual patient’s health and risk classification.The choice between surgery, radiation, and hormone therapy is highly personalized. It often depends not only on clinical factors — like PSA level (the level of the prostate-specific antigen protein in the blood), Gleason Score (which measures how aggressive the cancer is), and tumor staging — but also on the patient’s age, overall health, lifestyle preferences, and tolerance for specific side effects.
Radical Prostatectomy (Surgery)
A radical prostatectomy is a surgical procedure that involves removing the entire prostate gland along with some surrounding tissues, and sometimes nearby lymph nodes. It is typically performed in patients with localized prostate cancer and may be done through traditional open surgery or more commonly through minimally invasive robotic-assisted surgery.
Common side effects include:
- Urinary Incontinence: Patients may experience leakage of urine, especially when coughing, laughing, or lifting heavy objects. This may improve over time, especially within the first year after surgery, but some patients may continue to experience mild to moderate leakage long-term.
- Erectile Dysfunction (ED): Damage to the nerves that control erections is a significant risk, even when nerve-sparing techniques are used. Most men will experience erectile dysfunction immediately after surgery, with varying degrees of recovery over time. Recovery can take up to 18-24 months, and medications or devices may be used to assist.
- Changes in Orgasm and Ejaculation: After prostatectomy, men can still achieve orgasm, but there is no ejaculation since the seminal vesicles and prostate are removed. Some men report a change in the sensation or intensity of orgasm.
- Infertility: The removal of the prostate and seminal vesicles results in the inability to ejaculate semen, rendering the patient infertile. Men who wish to have children should discuss sperm banking prior to surgery.
Dr. Dal Pra points out that there are special techniques that can be implemented to hopefully reduce side effects.
“In terms of erectile function, it depends on the surgical technique,” he explains. “If surgeons can preserve one or both neurovascular bundles, there is a better chance of maintaining function. It’s important for patients to talk to their urologist about the location of the lesion and if the nerves can be preserved.”
Radiation Therapy
Radiation therapy for prostate cancer uses high-energy rays to kill cancer cells. There are two main types: external beam radiation therapy (EBRT) and brachytherapy, which involves placing radioactive seeds inside the prostate.
Radiation is often used for patients with localized or locally advanced cancer, and may be combined with hormone therapy for higher-risk disease.
Common side effects include:
- Urinary Irritation or Obstruction: Patients may experience increased urinary frequency, urgency, or discomfort (dysuria). Some may feel like they need to urinate more often at night (nocturia) or may experience a slower stream. These symptoms usually improve over time, but can persist.
- Bowel Issues: Radiation can irritate the rectum, leading to symptoms such as diarrhea, rectal bleeding, or a sense of urgency. Long-term bowel complications are less common but can include proctitis or rectal ulcers.
- Fatigue: Many patients report fatigue during and after radiation therapy. This is generally mild to moderate and tends to improve in the weeks to months following treatment completion.
- Erectile Dysfunction: Radiation can affect the nerves and blood vessels involved in erections. ED tends to develop gradually, often becoming more noticeable 1-2 years after treatment.
- Secondary Cancer Risk: There is a small long-term risk of developing secondary cancers in the bladder or rectum due to radiation exposure, although this risk is considered low.
- Skin Changes (in EBRT): Some men undergoing external beam therapy may notice mild skin irritation in the treatment area, similar to a sunburn. This is usually temporary.
Hormone Therapy (Androgen Deprivation Therapy)
Hormone therapy for prostate cancer works by reducing or blocking the body’s production of testosterone, which fuels the growth of prostate cancer cells. It may be used in combination with radiation therapy, especially in intermediate- or high-risk cases, or in men with metastatic or recurrent disease.
ADT can be administered through injections (such as leuprolide or degarelix), oral medications, or in some cases, surgical castration (orchiectomy).
Common side effects include:
- Hot Flashes: These can be one of the more frequent and bothersome side effects. These are similar to menopausal symptoms in women and can include sudden feelings of warmth, sweating, and flushing.
- Loss of Libido and Erectile Dysfunction: Decreased testosterone levels usually lead to reduced sexual desire and can cause erectile dysfunction, often more severe and persistent than with surgery or radiation.
- Fatigue and Weakness: Many men on ADT experience a lack of energy and a general sense of fatigue, which can affect quality of life.
- Weight Gain and Muscle Loss: Hormone therapy can lead to changes in body composition, including an increase in fat mass and a decrease in muscle mass.
- Bone Thinning (Osteoporosis): Prolonged hormone therapy can lead to reduced bone density, increasing the risk of fractures. Bone-strengthening medications and supplements may be recommended.
- Mood Changes and Cognitive Effects: Some men experience mood swings, irritability, depression, or mild cognitive decline. These symptoms can vary in intensity and may require medical management.
- Increased Cardiovascular and Metabolic Risk: ADT may raise the risk of diabetes, high cholesterol, and heart disease. Regular monitoring and lifestyle interventions are important.
Choosing The Right Treatment: Risks vs. Benefits
The side effects of prostate cancer treatments can vary widely from patient to patient. Some men may tolerate certain therapies better than others, and for many, the potential side effects are worth the benefits of long-term cancer control or cure.
It’s essential that men discuss their treatment options thoroughly with their healthcare providers, considering both cancer aggressiveness and quality-of-life factors.
“There are very important ways to mitigate all of these side effects,” Dr. Dal Pra explains. “One thing that I like to emphasize every time I see my patients is the importance of regular physical activity. There have been many, many studies correlating regular physical activity with a decreased risk of prostate cancer progression, with an improvement of body profile, wellbeing, even bladder function. There are so many benefits.”
Questions To Ask Your Doctor
- What are the possible side effects from my treatment plan?
- What can we do before treatment to help mitigate side effects?
- What are my options after treatment to help deal with side effects?
- Will I need to make any lifestyle changes or adjustments?
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