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After Treatment for Prostate Cancer

Managing Side Effects


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You may feel embarrassed talking about some of these side effects, but remember that your doctor is there to help you feel better and live as comfortably as possible.

Some men who receive treatment for prostate cancer have side effects caused by treatment. These side effects may include incontinence (the inability to control urination), bowel problems, impotence (the inability to get an erection), infertility (the inability to father a child), hormonal changes, and side effects of chemotherapy, such as fatigue. Men receiving treatment for prostate cancer may have one or more of these side effects. However, not every man has every side effect; some men have few or none. Talk with your doctor to learn more about your risk of side effects.

It is important to let your doctor know if cancer treatment is causing any side effects. You may feel embarrassed talking about some of these side effects, but remember that your doctor and the healthcare team are there to help you feel better and live as comfortably as possible. Support services, such as support groups and counseling, may also help. Talk with your doctor or nurse about services available to help you manage any of the side effects discussed below.

Incontinence
Surgery to remove the prostate can cause incontinence, a common side effect of prostate cancer treatment. Incontinence may be short-term (temporary) or long-term (permanent). There are four types of incontinence. Stress incontinence is the most common type of incontinence after prostate surgery. Men with stress incontinence leak urine when they cough, laugh, sneeze, or exercise. Men with overflow incontinence take a long time to urinate and have a dribbling stream of urine. Men with urge incontinence have a sudden need to urinate. In rare cases, men lose all ability to control their urine. This condition is called continuous incontinence.

If you have incontinence, limit the amount of coffee and alcohol you drink, and urinate before bedtime and before strenuous activity. Techniques called Kegel exercises tone the muscles that hold urine. You perform Kegel exercises by tightening or clenching the muscles in your pelvis. When you tighten your muscles to stop the flow of urine or to prevent passing gas, you are doing a Kegel exercise. A technique called biofeedback and electrical stimulation can help you do better Kegel exercises. Ask your doctor for more information about Kegel exercises and biofeedback.

Medications, such as oxybutynin (Ditropan) and tolterodine (Detrol), can help with both stress incontinence and urge incontinence. Talk with your doctor about the use of medications to treat incontinence. To control leakage, wear an absorbent pad inside your underwear. You can buy pads at your local grocery store or drugstore. Surgery to increase the size of the bladder or surgery to implant an artificial urinary sphincter (a valve that controls the flow of urine from the bladder) may be treatment options for permanent incontinence. Talk with your doctor if your incontinence does not improve.

For some men, impotence is temporary and goes away after time. If you have had surgery to remove your prostate, impotence is more likely to be permanent.

Bowel Problems
Some men with prostate cancer who receive radiation treatment may have bowel problems during and after treatment. These problems are more commonly caused by external beam radiation than brachytherapy or internal radiation therapy. Possible bowel problems are diarrhea, gas, loss of control of bowel movements, and bleeding with bowel movements.

Many men are able to manage bowel problems by taking over-the-counter medications. Most of these problems go away over time, but sometimes, normal bowel function does not return after treatment ends. Talk with your doctor about any bowel problems you are having.

Impotence
Impotence is also called erectile dysfunction (ED). Surgery, radiation therapy, or hormone therapy can cause some men to become impotent.

For some men, impotence is temporary and goes away after time. If you have had surgery to remove your prostate, impotence is more likely to be permanent. If you have impotence caused by hormone therapy, your ability to have an erection may improve after your treatment ends. If you have been treated with radiation therapy, you may not have any signs of impotence until months after your treatment ends.

Coping with impotence may be difficult. The following methods may help you manage impotence and achieve erections:

  • Medications, such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis);
  • A medication called alprostadil (Caverject, Edex, Muse) that you inject in the skin at the base of the penis before sex. Pellets of alprostadil can also be inserted into the penis through the urethra;
  • A tube called a vacuum constriction device that you place over the penis to create suction, which may also help you get an erection; and
  • A prosthesis (artificial implant) that is surgically placed into the penis.

Talk with your doctor about these options and ask about available support services. In addition, talking with your partner and finding counseling may help both of you cope with this problem.

Infertility
Surgery, radiation treatment, and chemotherapy may cause temporary or permanent infertility in men being treated for prostate cancer. Medical procedures done before treatment, such as sperm banking, help prevent infertility. However, there are options and medical procedures available to men who remain infertile after cancer treatment and who did not undergo any methods to preserve fertility before starting treatment. An example of one procedure is called testicular sperm extraction. In this procedure, sperm cells found in tissue removed from a man’s testicles are used in a fertility procedure or frozen for later use.

Hormonal Changes
Many men with prostate cancer who are treated with hormone therapy have side effects related to this treatment. Common side effects are impotence and a decreased desire to have sex. Many men treated with hormones also have side effects that are similar to women going through menopause, including hot flashes, growth of breast tissue, depression, weight gain, loss of muscle mass, osteoporosis (bone thinning), which can cause broken bones, and low red blood cell counts, which can cause anemia (a condition that can make you feel tired). The risk of high blood pressure, diabetes, and heart attacks is also higher in men treated with hormone therapy.

Many of these side effects can be prevented or treated. Hot flashes can be helped by treatment with hormones, antidepressants, and a drug called gabapentin (Neurontin). A small amount of radiation treatment to the breasts can help prevent them from growing. Medications called bisphosphonates help treat osteoporosis. Examples include alendronate (Fosamax) and zoledronic acid (Zometa). Depression can be treated by antidepressants and counseling. Exercise can help stop weight gain and the loss of bone and muscle mass. Exercise also reduces fatigue.

Chemotherapy Side Effects
Chemotherapy is the use of drugs to treat cancer. Chemotherapy is sometimes used if prostate cancer has spread outside of the prostate gland and hormone therapy is not working.

Side effects of chemotherapy depend on the type of chemotherapy you receive, the amount taken, and the length of treatment. Some side effects of chemotherapy include nausea and vomiting; loss of appetite; hair loss; sore mouth, gums, or throat; dry skin; increased chance of bruising and bleeding; infection; and fatigue. If you have side effects from chemotherapy, talk with your doctor, as there is help for many side effects caused by chemotherapy.

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Source: Excerpted with permission from www.cancer.net, copyright © 2009 American Society of Clinical Oncology. All rights reserved.

This article was published in Coping® with Cancer magazine, September/October 2009.