Prostate cancer treatment: strategies for managing side effects

After skin cancer, prostate cancer is the most common cancer diagnosed in men in the U.S., with one in eight men at risk of being diagnosed with this cancer during his lifetime. If you or a man you care about is undergoing prostate cancer treatment, you may be living with treatment-related side effects. These can vary depending on the type of treatment, including hormone therapy, radiation, surgery, immunotherapy, cryotherapy, and chemotherapy.

Some of the most common side effects include incontinence, erectile dysfunction, infertility, and fatigue. The good news is that there are approaches that can help you manage and mitigate these side effects in most cases.

Managing incontinence

Men may face several types of incontinence after treatment, including stress incontinence, overflow incontinence, and urge incontinence. To help manage this, talk with your doctor about these strategies:

Kegel exercises to strengthen the muscles that stop the flow of urine
Drinking less fluid and avoiding caffeine, alcoholic beverages, and spicy food
Urinating before the urge is strong
Losing weight
Anticholinergic medications to stop the bladder from contracting or spasming or medications that reduce the amount of urine produced
Catheters to drain urine from the bladder, including a non-invasive catheter called a condom catheter
Surgery, including minimally invasive, endoscopic urethral bulking procedures to decrease the size of the urinary passageway; a bulbourethral sling to support and compress the urethra; and an artificial urinary sphincter to control the release of urine

Treatments for erectile dysfunction (ED)

One option for treating ED is oral medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These medications relax the muscles in the penis, allowing blood to flow to the organ more freely and quickly.

If these medications aren’t effective or you can’t take them because you have other conditions that make taking them risky or you take other drugs (like medications for angina or other heart problems and alpha-blockers to treat high blood pressure) that may cause drug interactions, talk to your doctor about these other options:

A very small medicated pellet inserted into the urethra to stimulate blood flow to the penis called Alprostadil (MUSE) and an injectable form of Alprostadil sold under the brand name CaverJect
Vacuum pumps to mechanically create an erection
Penile implants that include a plastic tube, small fluid-filled balloon attached to the abdominal wall, and a release button placed in the testicle

Preserving fertility

Treatment of prostate cancer causes infertility in most men. Talk with your doctor about sperm banking and artificial insemination before you begin treatment if you plan to have children in the future. Another available option is to extract sperm from the testicles and inject it into an egg. If the egg is fertilized, it can be implanted in the uterine wall. However, this approach has a relatively low success rate—less than 50 percent.

Coping with fatigue

Recovering from surgery, undergoing radiation and chemotherapy for advanced prostate cancer can all cause fatigue. Exercise can help you increase your stamina and feel less fatigued but talk with your doctor before starting any physical activity to make sure it’s safe for you. Some good, low-impact options include walking, biking, and swimming, as well as strength training with resistance bands, bodyweight, or light hand weights. You may want to start exercising with a physical therapist to guide you.

Mitigating the effects of hormone therapy

Hormone therapy may increase your risk for osteoporosis in the future. Make sure your primary care physician is aware that you’ve undergone this treatment so your bone mineral density can be tracked, usually with a DEXA scan. Your doctor may recommend medications to slow bone loss or build new bone.

This approach to treatment can also affect your heart health and cause weight gain. You should get your cholesterol and heart function checked regularly so you and your doctor can build a strategy to lower the risk of a future heart attack or stroke. In addition to eating a heart-healthy diet and getting regular exercise, which will also help you manage your weight, your doctor may prescribe medications to control your cholesterol and blood pressure.

Depression can be another hormone therapy side effect. If you’re experiencing symptoms of depression, consider working with a mental health care provider. You can also try exercise and stress management strategies including meditation, Tai Chi, and yoga to manage your symptoms.