Advanced prostate cancer- How can my side-effects be managed?
Some symptoms of prostate cancer can be linked to the cancer itself or they may be due to treatment. Your symptoms will often depend on how your cancer has affected you. You may experience symptoms such as:
It is unlikely that you will have all of these symptoms or even most of them. If you have any symptoms that are troubling you, let your doctor or nurse know. There are treatments that can help to make your life easier and more comfortable.
Difficulty emptying your bladder
Some men with prostate cancer have trouble passing urine if the cancer has spread to around the prostate, urethra (water pipe) or bladder. Some of the symptoms you might experience include:
A slow flow of urine
Difficulty emptying your bladder
Sudden need to pass urine with little warning
Dribbling after passing urine
Getting up at night to pass urine
Blood in the urine
Occasionally, some men find they cannot pass urine at all and cannot empty their bladder. This is called acute urinary retention. This may be due to the cancer pressing on the tube which drains the bladder (the urethra) and making it more narrow than normal. This can become very uncomfortable and distressing. Not being able to pass urine also increases the risk of developing a bladder infection if it is not attended to promptly.
You need to go to the hospital accident and emergency unit where they will fit you with a small, thin tube (catheter) to drain your bladder. The urine you make will pass through the tube into a drainage bag. Before you go home, your nurse will show you how to look after the catheter. The catheter drainage bag will be worn inside your trousers and will be secured around your lower leg.
It is important that the urine can drain easily from your bladder and into the drainage bag. Try to drink plenty of fluids every day (between 1.5 and 2 litres is usually best) so as to reduce the risk of getting an infection.
Wash your hands before and after handling the catheter. When washing the catheter entry tip, wash it in a one-way direction away from your body. Speak with your nurse if you notice any leaking around the outside of the catheter or if you notice that the catheter is not draining correctly.
You might experience bladder spasm while the tube is in place. This often feels like a strong urge to pass urine, despite the tube being there. It may happen when your bowels move. This is normal, but talk to your doctor or nurse if this happens to you a lot. Your doctor can prescribe medication if this becomes a problem for you.
Some men may need an operation to relieve the pressure on the narrowed urethra (water pipe). This is called a transurethral resection of the prostate (TURP).This will allow the urine to flow better.
Some men may notice that they don’t get much warning before they have the urge to pass urine and may leak some urine before making it to the bathroom. This may be as a result of the cancer growing inside the bladder or near the muscles which control the opening and closing of the bladder, causing them to weaken.
If this is the case you might need to wear an absorbent pad inside your underwear for protection and pelvic floor exercises may help to strengthen the muscles. You could talk to the public health nurse or a pharmacist about the special pads for men that are available. If you have a medical card, your public health nurse can assess your incontinence and help with a supply of pads.
If you would like more information on how to manage any urinary symptoms visit our section Urinary symptoms, catheters and prostate cancer treatment or call our Cancer Nurseline Freephone 1800 200 700.
Not all men with advanced prostate cancer have pain. But one of the first signs that cancer has spread to the bone can be an ongoing nagging ache in your bone. This can be sore when you move around and make it hard to sleep.
Remember pain in your bones can be caused by other things such as arthritis, simple sprains and everyday aches and pains as you get older. If you have a new ache that lasts more than a few weeks, talk to your doctor. He or she can organise tests to find the cause of the pain.
If you do get pain, it can be helped by painkillers or cancer treatments. Your doctor will decide which painkiller is best suited to the type of pain you have. If the medication does not kill the pain, tell your doctor or nurse. Mild pain is often helped by drugs such as paracetamol or anti-inflammatory drugs like ibuprofen. Moderate and severe pain will need stronger painkillers such as codeine or morphine.
Your GP can advise you about which pain medication to take or you might see a specialist who manages pain and other symptoms. They can arrange for you to try out different painkillers to see which one suits you best. Besides painkillers, a number of other drugs can be helpful in reducing pain.
If you are troubled by pain, call the Cancer Nurseline on 1800 200 700 for advice. Ask for a copy of the factsheet called Cancer Pain. Alternatively visit your local Daffodil Centre if there is one in the hospital you attend.
Drugs known as bisphosphonates can also help to relieve bone pain. They work by helping to strengthen bone and so prevent bone damage such as fractures (breaks).
For more information, call the Cancer Nurseline on Freephone 1800 200 700. Ask for a factsheet called Bone health.
Radiotherapy uses high-energy X-rays to treat cancer cells on the bone. When radiotherapy is given externally, it is called external beam radiotherapy. Radiotherapy is very good for treating bone pain so you might have radiotherapy if your cancer has spread to your bones and is causing you pain. In this situation, the treatment cannot cure the cancer. But it can reduce symptoms like pain and make you more comfortable and feel better. This is known as palliative radiotherapy.
Some preparation is needed before the actual radiotherapy can be given. Before treatment, you will visit the hospital for planning scans that use a machine called a simulator. This helps your doctors to work out exactly where to aim the X-rays. They will mark your skin so that the beam goes to the same area each time you get radiotherapy.
What does the treatment involve?
Before you have each treatment, the hospital staff will help you into the right position on the radiotherapy table. They will use the marks on your body to make sure that the treatment is given to the right spot each time. Before the treatment starts, the staff will leave the room. They can see and hear you at all times and you can talk to them.
During the treatment the machine will move around your body, but it does not touch you and you will not feel anything. The radiation does not stay in your body after the treatment, so it is perfectly safe to be around other people at all times afterwards.
Radiotherapy can be given as a single dose or divided over a few days. You might find that your pain slightly increases a bit during and in the immediate days following treatment, before it starts to feel better. Tell the doctor or nurse if you are experiencing pain and you can be prescribed stronger pain killers to make you more comfortable.
You might get relief from the pain within a few days or a few weeks, depending on your situation.Your doctor and radiation therapist will explain what is involved and any likely side-effects. Many men can reduce their dose of painkillers afterwards, but you can still take them if needed. Radiotherapy can also help with any pressure or bleeding. In this case again, radiotherapy does not cure the cancer but can help you feel better.
Side-effects of external beam radiation
Side-effects occur when the normal healthy cells near the treated area are exposed to the beam of radiation. Some side-effects appear during the treatment while others can develop afterwards.
The most common side-effects are those that develop during or shortly after your treatment. They may include fatigue and skin reactions, where the skin over the treated area may become temporarily red. Not all men will get all of the side-effects. There is no way of knowing which of them you will get or how much trouble they will cause you. During your treatment, your radiation therapists can discuss your side-effects and advise you on how best to manage them.
If you would like more information on radiotherapy, call the Cancer Nurseline on 1800 200 700 for a free copy of the booklet Understanding Radiotherapy or visit a Daffodil Centre if there is one in the hospital you visit.
You can also download the booklet Understanding advanced (metastatic) prostate cancer. You might also like to view our radiotherapy page for further information.
Sometimes a radioactive injection can help with symptoms of prostate cancer that has spread to the bones, by shrinking the bone cancer and slowing its growth. Your doctor will tell you if this treatment is suitable for you or not. Examples of radioactive injections are strontium, samarium and radium-223 (Xofigo ®).
This treatment can also help to ease bone pain due to cancer. It may take up to 3 weeks for the pain to reduce but the effect of the treatment can last for several months. You can have this treatment as an outpatient. The radiation is first injected into a vein, usually in your arm, then it travels to your bones, where it affects the cancer cells.
After the injection, it is quite safe to be around people and pets, but a small amount of radiation remains in your urine and blood and so you should take some precautions to reduce the risk of others being exposed to the radiation. It is best to use flush toilets instead of urinals afterwards and flush the toilet a couple of times after passing urine as well. Be careful of any spills of urine or blood too. The radiation usually lasts about 7 days. Your doctor or nurse will discuss any special precautions with you before you go home.
There are other ways to control pain too. For example, some complementary therapies that involve relaxation can help to ease aches and pains and make you feel more comfortable. Talk to your local cancer support centre to see what services are available. For example, some centres provide yoga, Reiki and meditation classes. Call the Cancer Nurseline on 1800 200 700 for advice or for a copy of the booklet, Understanding Cancer and Complementary Therapies. You can also visit your local Daffodil Centre if there is one in the hospital you attend.
Cancer in your bone can cause bone pain. It also causes weaker bones, making you more prone to fractures. Receiving treatment with hormone therapies can also weaken your bone by making them thinner. Your doctor can advise you on treatments and lifestyle measure to strengthen your bones.
Drugs such as denosumab (Xgeva®) or zoledronic acid (Zometa®) can be given to help strengthen your bones. Zoledronic acid belongs to a family of drugs called bisphosphonates, which help to strengthen bone.
Bisphosphonates and denosumab can strengthen bones affected by prostate cancer or weakened by cancer treatment. They can help to prevent further bone loss and strengthen the bone to reduce the risk of bone damage, like fractures. They can also help to reduce pain from cancer that has spread to the bone and may slow the growth of cancer that has spread to your bone.
For more information about bone-strengthening drugs, call our Cancer Nurseline Freephone 1800 200 700. Ask for a print copy of our Bone Health factsheet.
In some situations your bones may become very weak or unstable and more prone to fracture (break). If your bones are very weak your doctor might discuss the option of surgery with you. This surgery involves inserting a metal plate or pins to help strengthen or stabilize the bone. This helps to avoid a spontaneous fracture. This is where a bone breaks by itself, without a known injury. The decision around surgery as an appropriate treatment will be influenced by which bone is involved and whether you would be fit enough to undergo the operation.
Constipation can be a common problem if you have advanced prostate cancer, especially if you are taking painkillers. If this happens, you can talk to your doctor as soon as possible. He or she will want to examine you and find the cause before advising you on the best treatment.
Constipation might also be linked to a low-fibre diet, not drinking enough fluids, not eating enough, or not being active enough. Ask to talk to the dietician at the hospital. He or she can help you to plan a diet high in fibre with plenty of fluids. Gentle exercises can help to keep your bowel movements regular too. Your doctor or nurse can advise you on the best kind of exercise for you.
Fatigue is a common symptom of cancer and may be described as an overwhelming tiredness. Often it is not relieved by rest. If you have fatigue you may find it hard to concentrate or make decisions. The reason for the fatigue can sometimes be hard to identify. It can be caused by treatments or by the cancer itself. Whatever the reason, there are things you can do that can help.
Try to listen to your body and take a rest if you need to, even in the middle of the day. It helps to learn how to pace yourself as well. Give yourself time for something you enjoy when you are feeling least tired. If your illness allows you to do physical exercise, do some regularly.
For example, a regular, gentle walk might be a realistic goal and will boost your morale when you achieve it. Get others to help you with chores or with travelling to hospital. Download our helpful booklet called Coping with Fatigue or get a free copy from a Daffodil Centre or by calling the Cancer Nurseline Freephone 1800 200 700.