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Prostate Cancer 101

Understanding Side Effects

Treatments for prostate cancer can be associated with various side effects. While some side effects may be temporary, others can be permanent and may not improve over time. Not all side effects occur in every patient since they depend on the type of treatment and the individual patient response. Some side effects may significantly impact the man with prostate cancer and his family so it is important to keep an open dialogue with your doctor about the potential side effects of each treatment.


Possible Side Effects of Prostate Cancer Treatment

Treatment options for prostate cancer can lead to a range of side effects. Dr. Arthur Burnett, Patrick C. Walsh Distinguished Professor of Urology, Director, Basic Science Laboratory in Neurourology and Director, Male Consultation Clinic at Johns Hopkins Medical Institutions discusses these possible side effects and how men and their family and caregivers can manage the impact of treatment.

Treatment Potential Associated Side Effects
Surgery Removal of the prostate via surgery, or a prostatectomy, may carry long term risks of urinary incontinence (trouble controlling urination leading to urinary leakage) and erectile dysfunction (difficulty attaining and/or maintaining an erection for sexual activity). It is also possible to form scar tissue at the surgical site, leading to difficulty emptying the bladder. Short terms risks of prostate cancer surgery include the risks of an operation under anesthesia including but not limited to blood loss, infection, nerve injury, heart attacks, and blood clot formation.
Radiation Therapy (EBRT and brachytherapy) Common side effects of radiation therapy are urinary problems, which usually disappears with time. This can include issues such as increased frequency, blood in the urine, burning sensation, and/or weak stream. Erectile dysfunction, or difficulty attaining and/or maintaining an erection for sexual activity, may also develop, even years after radiation therapy. Patients who undergo EBRT may experience skin issues such as itchiness, discomfort, and darkening of the skin. Additionally, the effect of radiation on the lining of the rectum and bowels may lead to some abdominal discomfort as well as diarrhea and excessive gas. Patients may also experience at least a mild degree of fatigue during and shortly after their EBRT. Brachytherapy may cause pain and bruising in the perineum and testicles. Although it is rare, there is a slight increase in the likelihood of new cancers forming in the pelvis years after radiation therapy for prostate cancer.
Hormonal Therapy Androgen Deprivation Therapy (ADT)

The most common side effects associated with androgen deprivation therapy (ADT) include hot flashes, decreased libido, and increased bone fracture risk. Additional, less specific effects include fatigue, increased risk of diabetes and heart attacks/strokes, weight gain, cholesterol increase, decreased muscle mass, anemia, and memory loss.

Secondary Hormonal Therapy

Use of diethylstilbestrol (DES) is associated with cardiovascular complications, including blood clots and heart attack. Ketoconazole is associated with fatigue, abdominal pain, hepatotoxicity, and nausea; abiraterone may cause shortness of breath, low potassium, and edema; enzalutamide may cause muscle pain, diarrhea, and edema.
Chemotherapy It is important to note that the chemotherapy you might receive for prostate cancer is likely to be very different than the chemotherapies your friends and family members may have received for other cancers. While there are over 50 chemotherapy medications used for cancer treatment, only 3 are used in prostate cancer patients. Potential side effects of chemotherapy for prostate cancer include anemia, neutropenia, fatigue, nausea/vomiting, diarrhea, and pain.
Immunotherapy The side effects of immunotherapies such as sipuleucel is mostly limited to infusion reactions, which include chills, fatigue, back pain, nausea, joint aches, and headache. These effects are not long lasting but can often be prevented with careful monitoring during infusion.
Bone-targeted therapy Bone-targeted therapy such as radium 223 dichloride may be associated with fatigue, nausea, anemia, and pain.

More About Potential Side Effects

Following surgery or radiation therapy, as well as during hormonal therapy, a majority of prostate cancer patients experience some degree of erectile dysfunction (ED) – the inability to attain and/or maintain an erection that is sufficient for satisfying sexual activity. Newer, surgical nerve-sparing techniques used during surgery for certain patients can reduce some of this side effect, but it is common for at least some degree of ED to be present after treatment. If ED becomes a problem, your doctor can prescribe ED medications that can be helpful for some patients.

Loss of natural fertility and ejaculation is an unavoidable side effect of surgery (radical prostatectomy). Loss of fertility may also occur in association with radiation therapy and chemotherapy due to disruption of normal semen production and ejaculation. Hormone therapies such as ADT and particularly surgical castration also produce complete infertility. For this reason, prostate cancer patients who wish to father children in the future may elect to bank their sperm.

A large proportion of men experience urinary issues in association with surgery or external beam radiation therapy (EBRT). The most common urinary issue after surgery is incontinence, or the inability to control the flow of urine from the bladder. Generally, the degree of incontinence will improve over the first year following surgery, but some men may be left with a permanent problem. There are procedures (ex. slings and artificial urinary sphincter implants) that can help men with permanent or bothersome urinary incontinence. Additional urinary issues include pain or difficulty urinating, an urgency to urinate, and hematuria (blood in the urine); these may be more common after radiation therapy for prostate cancer.

Fecal incontinence (also referred to as bowel dysfunction) is the inability to control defecation (bowel movements). It may occur in patients who undergo radiation therapy, especially external beam radiation therapy (EBRT). This is typically a short-term side effect and less common in the modern era of radiation treatment.

Proctitis is an issue most men undergoing EBRT will experience; it includes some degree of irritation to the rectum during treatment and sometimes bleeding from the rectum/anus. For most men, this is temporary and can be treated with suppositories and gentle enemas.

 

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