Supportive care for prostate cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of prostate cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from prostate cancer and adjusting to life after treatment is different for each person, depending on the stage of cancer, the organs or tissues removed during surgery, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. If you have been treated for prostate cancer you may have the following concerns.

Coping with your emotions

Going through many emotions is a normal part of having cancer, whether you've just been diagnosed, finished treatment or found out that cancer has come back. Many people describe this as being on an emotional roller coaster.

Everyone reacts to a cancer diagnosis in their own way. It's hard to predict how quickly or easily someone will adjust to the situation. How you react and adjust to living with cancer often depends on how you face other problems and crises. Learning about the emotional effects of cancer can help you cope. It can also help you understand and support others through these hard times.

Find out more about coping with your emotions and coping with anxiety and stress.

Dealing with practical matters

When you have cancer, many things may feel like they are out of your control. You may worry about your job or dwell on money concerns. You may have new expenses to pay for, like help around the house or renovations to fit your new needs. Things such as travelling may need to be thought about in a whole new way.

Find out more about planning for the future, finances, work and travel.

Getting support and talking about cancer

Talking about cancer isn't easy. It's hard to know what to say. And it's hard to predict how others will react to news of a diagnosis, to updates about treatment or to hearing that cancer has come back. You may worry that you'll start to cry or that talking about your feelings is a sign of weakness. You may avoid talking about how you feel because you don't want people to get upset or worry about you.

But it's good to talk. It can help you understand your own emotions and feel more in control. It can make your relationships stronger and help people understand what you're going through. And it's the first step to getting support. Simply having someone listen can help you. And once people know what you're going through, they usually want to help in other ways as well.

Find out more about talking about cancer.

Self-esteem and body image

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Prostate cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments, such as hormone therapy or surgery, can result in body changes, such as:

  • loss of body weight and muscle mass
  • growth or tenderness of the breast tissue
  • hot flashes and mood swings
  • loss of one or both testicles
  • loss of bladder control (called urinary incontinence)
  • sexual problems, including erectile dysfunction

Some of these changes can be temporary. Others will last for a long time or be permanent.

Your healthcare team can help you find a counsellor or give you resources to help you cope with self-esteem and body image issues. They can also suggest other resources to help you. For example, you may choose to have testicular prosthesis surgery if you had one or both of your testicles removed. This surgery helps improve the appearance of the scrotum after your testicle is removed.

Sexuality

Many men continue to have strong, supportive relationships and a satisfying sex life after prostate cancer. If sexual problems happen because of prostate cancer or its treatments, there are ways to manage them.

Most men with prostate cancer are older when they are diagnosed, so not being able to get someone pregnant is often not an issue. Be sure to talk to your doctor if you have concerns about how treatment may affect your fertility.

Types of sexual problems

The following sexual problems can happen because of prostate cancer treatment.

Erectile dysfunction means not being able to get and keep an erection firm enough to have sex.

Retrograde ejaculation means that during orgasm the semen flows backward into the bladder and mixes with urine (pee), rather than coming out through the penis. This can happen in those who have had a transurethral resection of the prostate (TURP).

Dry orgasm means that a man reaches sexual climax but doesn't ejaculate semen. It can happen after a radical prostatectomy because this surgery removes the prostate and seminal vesicles, which make most of the fluid in semen. As a result, men who have this surgery aren't able to get someone pregnant naturally.

Loss of sex drive is also called decreased libido. It is common to have less interest in sex when you are diagnosed with cancer and during treatment. Hormone therapy in particular can lower your sex drive because it lowers testosterone levels. Your sex drive can be low after treatment because you may worry that it will be painful or that you won't be able to get an erection or have an orgasm.

Getting help

You might need help to deal with sexual concerns or problems. Health professionals who specialize in sexual problems can provide information and support to people with cancer and their partners. Sexual counselling can be done on a one-to-one basis, with a partner or in a group. Counselling can help you talk openly about your problems, work through your concerns and discover new ways of coping or finding sexual pleasure.

Talk to your healthcare team about resources available. They can suggest ways to cope with sexual problems, including physiotherapy, medicines, devices or prosthetics.

Find out more about sex, intimacy and cancer and ways to manage sexual problems.

Urinary incontinence

Urinary incontinence is a loss of bladder control. It can happen when a tumour in the prostate grows, presses on the urethra and blocks the flow of urine from the bladder. Surgery or radiation therapy for prostate cancer can also damage the nerves or muscles that control the bladder or the release of urine. Radiation therapy can also irritate the lining of the bladder, which can lead to the need to urinate often and an urgent need to urinate.

Urinary incontinence may be embarrassing and inconvenient, but it can be treated with medicine, surgery, changes in behaviour or medical devices to achieve better control.

Find out more about urinary incontinence.

Bowel problems

If you are treated with radiation therapy, you may develop bowel problems such as irregularity, excessive flatulence, cramping or diarrhea. Talk to your healthcare team if you have bowel problems. They can suggest changes to your diet or prescribe medicines that can help you manage these problems.

Fatigue

Fatigue causes a person to feel more tired than usual and can interfere with daily activities and sleep. It may be caused by a low red blood cell count (called anemia), specific drugs, poor appetite or depression. It may also be related to toxic substances that are made when cancer cells break down and die. Fatigue may get better as time goes by, or it can continue long after you have finished cancer treatment.

Find out more about fatigue.

Osteoporosis and bone fractures

Osteoporosis is when bones lose mass (density) and the bone tissue breaks down. Some hormone therapies used to treat prostate cancer can increase the risk for osteoporosis. These therapies lower the amount of testosterone in the body so cancer cells can't use it to grow. But testosterone also plays a role in maintaining strong bones, so hormone therapies that lower testosterone levels can cause bone loss. Cancer that has spread to the bones can also lead to bone weakness and fractures.

Finding and treating osteoporosis early can help prevent bone loss and bone fractures. Treatment for osteoporosis includes drugs called bisphosphonates and denosumab. It is important to also take calcium and vitamin D.

Find out more about osteoporosis.

Fear of recurrence

If you are treated for prostate cancer, you may worry that it will come back (recur). It is important to learn how to deal with these fears to maintain a good quality of life.

If you find that you're worried and anxious all the time, or if your anxiety is interfering with your daily life, you may want to talk to a counsellor. It is important to get worries under control so you can focus on living, take care of your health and make the most of each day.

Find out more about worrying that cancer will come back.

Second cancers

Survivors of prostate cancer have a higher risk of developing a different (second) cancer including:

  • small intestine cancer
  • soft tissue sarcoma
  • bladder cancer
  • thyroid cancer
  • thymus cancer
  • melanoma skin cancer
  • rectal cancer
  • acute myelogenous leukemia (AML)

The risk of developing a second cancer is linked to having certain genetic mutations or making certain lifestyle choices. Radiation therapy can also increase the risk for a second cancer, depending on the type and dose used. But the benefit of treating prostate cancer with radiation therapy usually far outweighs the risk.

Living a healthy lifestyle and developing a wellness plan

Living a healthy lifestyle that includes avoiding tobacco, eating well, getting enough physical activity, maintaining a healthy weight and limiting alcohol may help you live longer and lower your risk of recurrence or developing a second cancer. Your healthcare team can help you to develop a wellness plan for staying healthy. Routine screening to find a second cancer early, being aware of changes in your health and reporting problems to your doctor are also important parts of follow-up care after cancer treatment.

Nutrition

Eating a healthy, well-balanced diet that includes a variety of food groups can help you recover from prostate cancer. Eating well can also help you to live longer and may help lower your risk of developing a second cancer.

While recovering from prostate cancer, try to:

  • eat a diet high in vegetables, fruit and whole grains
  • limit high-calorie foods and beverages
  • eat a diet low in saturated fat

If you received hormone therapy or radiation therapy to treat prostate cancer, be sure to talk to your doctor or a dietitian about the best nutrition for you. Research shows that getting enough vitamin D and calcium can help prevent osteoporosis and bone fractures in those having hormone therapy. Some men who receive radiation therapy have problems properly absorbing nutrients from food.

Find out more about eating well.

Questions to ask about supportive care

To make the decisions that are right for you, ask your healthcare team questions about supportive care.

Expert review and references

  • American Cancer Society. Prostate Cancer. Atlanta, GA: American Cancer Society; 2015: http://www.cancer.org/acs/groups/cid/documents/webcontent/003134-pdf.pdf.
  • American Society of Clinical Oncology. Prostate Cancer. 2014: http://www.cancer.net/cancer-types/prostate-cancer/view-all.
  • Barauskas Dorff T, Pinski J . The hormonal management of prostate cancer. Nargund VH, Raghavan D, Sandler HM (eds.). Urological Oncology. Springer; 2015: 48: 817-834.
  • Garnick MB (ed.). Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
  • Hu MI, Jiminez C, Busaidy NL, Habra MA . Endocrinologic issues. Foxhall LE, Rodriguez MA (eds.). Advances in Cancer Survivorship Management. New York: Springer; 2015: 21: 343-360.
  • Klemanski, D. and Lester, J. L . Chronic gastrointestinal and genitourinary symptoms. Lester JL & Schitt P (eds.). Cancer Rehabilitation and Survivorship: Transdisciplinary Approaches to Personalized Care. Pittsburg: Oncology Nursing Society; 2011: 12: pp. 113-122.
  • Krebs, LU . Altered Body Image and Sexual Health. Yarbro CH, Wujcik D, & Holmes Gobel B (eds.). Cancer Symptom Management. 4th ed. Jones & Bartlett Learning; 2014: 24:507-540.
  • Patterson, JL, Davis JW, Kim J, Hoffman KE, Osai WE, Kuban DA . Genitourinary cancer survivorship management. Foxhall LE, Rodriguez MA (eds.). Advances in Cancer Survivorship Management. New York: Springer; 2015: 7: 95-124.
  • Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W III, et al . American Cancer Society prostate cancer survivorship care guidelines. CA: A Cancer Journal for Clinicians. 201: http://onlinelibrary.wiley.com/doi/10.3322/caac.21234/full.