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 man, depending on where the cancer was in your body, the stage of cancer and 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. A man who has been treated for prostate cancer may have the following concerns.
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 a man’s self-esteem and body image. Often this is because cancer or cancer treatments, such as hormonal therapy or surgery, may 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, some men may choose to have testicular prosthesis surgery if they had one or both of their testicles removed. This surgery helps improve the appearance of the scrotum after your testicle is removed.
Many men continue to have strong, supportive relationships and a satisfying sex life after prostate cancer. If sexual problems occur 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 father a child 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 occur 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, rather than coming out through the penis. This can happen in men 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 father a child 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. Hormonal 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.
Some men might need help to deal with sexual concerns or problems. Health professionals who specialize in sexual problems can provide information and support to men 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 people talk openly about their problems, work through their concerns and discover new ways of coping or finding sexual pleasure.
Talk to your healthcare team about resources available. They can suggest ways men can cope with sexual problems, including physiotherapy, medicines, devices or prosthetics.
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 of 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.
Men treated with radiation therapy 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 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 is when bones lose mass (density) and the bone tissue breaks down. Some hormonal 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 hormonal 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. Research also shows that getting enough vitamin D and calcium can help prevent osteoporosis and bone fractures in men undergoing hormonal therapy.
Find out more about osteoporosis.
Many men who are treated for prostate cancer 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.
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, including the type and dose used, can also increase the risk for a second cancer. While the possibility of developing a second cancer is frightening, the benefit of treating prostate cancer with radiation therapy usually far outweighs the risk.
Living a healthy lifestyle that includes avoiding tobacco, eating well, getting enough physical activity, maintaining a healthy weight and limiting consumption of 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.
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 hormonal 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 men undergoing hormonal therapy. Some men who receive radiation therapy have problems properly absorbing nutrients from food.
There isn’t enough research to say that taking nutritional supplements of any kind can cure prostate cancer or lower the risk that it will spread to other parts of the body or come back after treatment.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
How can you stop cancer before it starts?
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