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Supportive care for prostate cancer

Supportive careSupportive careTreatment given to improve the quality of life of people who have a serious illness (such as cancer). 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 the extent of the disease, 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.

Incontinence

Urinary incontinence is the involuntary loss of urine or the inability to control urination. Urinary incontinence can occur in men with prostate cancer:

  • Enlargement of the prostate can obstruct the neck of the bladder neck. This can cause an overflow of urine when the bladder becomes too full (overflow incontinence).
  • Prostate surgery or radiation therapy can damage the nerves or muscles that control bladder function or the release of urine.
  • Pelvic radiation can cause irritation of the lining of the bladder, resulting in frequent urination and urgency.

Incontinence may be embarrassing and inconvenient, but it can be treated with medication, surgery or supportive measures to achieve better control.

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Self-esteem and body image

How a person feels about or sees themselves is called self-esteem. Body image is a person's perception of 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 may result in body changes, such as:

  • changes in body weight and muscle mass due to hormonal therapy
  • loss of the testicles (orchiectomy)
  • loss of bladder control
  • inability to get an erection

Some of these changes can be temporary, others will last for a long time and some will be permanent. For many people, body image and their perception of how others see them is closely linked to self-esteem.

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Sexuality

Many men continue to have strong, supportive relationships and a satisfying sex life after prostate cancer. Sexual problems that can occur because of prostate cancer treatment include:

  • Erectile dysfunction (ED) is the inability to get and keep an erection firm enough to have sex.
  • Retrograde ejaculation can result from prostate cancer surgery (TURP). It occurs when semen flows backward into the bladder and mixes with urine, rather than out through the penis during orgasm.
  • Dry orgasm can result from prostate cancer surgery (radical prostatectomy). A man who no longer produces semen may still have an orgasm. This is called a dry orgasm. A man who does not produce semen will not be able to father a child naturally.
  • Decreased libido (loss of sex drive) may result from reduced testosterone levels due to hormonal treatments and other side effects of prostate cancer treatment.

It is common to have a decreased interest in sex around the time of diagnosis and treatment. When the man first starts having sex after treatment, he may be afraid that it will be painful or that he will not have an erection or orgasm. The first attempts at being intimate with a partner may be disappointing. Some men and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.

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Fatigue

Fatigue causes a person to feel more tired than usual and can interfere with daily activities and sleep. It occurs for a variety of reasons. Fatigue may be caused by anemia, specific drugs, poor appetite, depression, or it may be related to toxic substances that are produced when cancer cells break down and die. Fatigue may get better as time goes by, or it can continue long after the person has finished their cancer treatment.

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Osteoporosis

Some hormonal therapies that are used to block or decrease the body's production of testosterone can increase the risk of osteoporosis. The hormone testosterone causes prostate cancer to grow, but it also plays a role in maintaining strong bones. Hormonal therapies that lower the levels of this hormone can increase bone loss. These therapies include luteinizing hormone–releasing hormone (LHRH) agonists and orchiectomy. Early detection and treatment of osteoporosis can decrease bone loss and reduce bone fractures.

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Nutrition

Men diagnosed with prostate cancer may have questions about the kind of food that is good for them. Diets that promote healthy, well-balanced eating from a variety of food groups will contribute to better health while recovering from prostate cancer. There is no research that shows taking nutritional supplements of any kind can cure prostate cancer. Some studies suggest a link between prostate cancer and a high-fat diet. It is wise to minimize the amount of fat in the diet. Men with prostate cancer should consult their doctor or dietitian about the best nutrition for them.

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Physical activity

The type and amount of physical activity a man can do after prostate cancer treatment often depends on:

  • the type of prostate cancer treatment he received
  • his overall health and physical condition

Heavy lifting and strenuous exercise should be avoided for a number of weeks after a radical prostatectomy, in order to allow the body to heal completely. Talk to the doctor or healthcare team before starting or resuming an exercise or physical activity program. Exercise can help a man return to the activities of daily living, reduce fatigue and improve energy levels.

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Returning to work

Many men continue to work while being treated for prostate cancer, but it is quite possible that their way of working will change. They may have to take some time off or adjust their work schedule to allow for treatment and recovery. Returning to work is an important part of returning to a normal routine after treatment.

Men with desk jobs should be able to return to work after 3 to 4 weeks. Men with jobs that are more physical and require lifting and bending will have to wait longer before returning to work. When the doctor gives the go-ahead, normal work activities can be started again.

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See a list of questions to ask your doctor about supportive care after treatment.

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