Prostate Cancer, Advanced or Metastatic

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Prostate Cancer, Advanced or Metastatic

Topic Overview

Is this topic for you?

This topic is about prostate cancer that has spread or come back after treatment. For information on early cancer of the prostate gland, see the topic Prostate Cancer.

What is prostate cancer?

Prostate cancer is a group of cells that grows faster than normal in a man's prostate gland. It can spread into other areas and kill normal tissue.

The prostate gland sits just below a man's bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.

The cancer may be one of these types:

  • Locally advanced prostate cancer. This is cancer that has grown through the outer rim of the prostate and into nearby tissue.
  • Metastatic prostate cancer. This is cancer that has spread, or metastasized, to the lymph nodes or other parts of the body.
  • Recurrent prostate cancer. This is cancer that has come back after it was treated. The cancer can come back in the prostate, near the prostate, or in another part of the body. If it comes back in another part of the body—often the bones—it is still called prostate cancer, because it started in the prostate.

What causes prostate cancer?

Experts don't know what causes prostate cancer. But they believe that getting older and having a family history of prostate cancer raise your chance of getting it.

What are the symptoms?

Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.

When they do appear, symptoms of locally advanced prostate cancer include:

  • Waking up many times during the night to urinate.
  • Having trouble starting your urine stream, having a weaker-than-normal stream, or not being able to urinate at all.
  • Having pain or a burning feeling when you urinate.
  • Having blood in your urine.
  • Having a deep pain or stiffness in your lower back, upper thighs, or hips.

Symptoms of metastatic prostate cancer may include:

  • Bone pain.
  • Weight loss.
  • Swelling in your legs and feet.

How is prostate cancer diagnosed?

Your doctor will do a digital rectal exam, in which he or she puts a gloved, lubricated finger in your rectum to feel your prostate. You may also have a blood test called a prostate-specific antigen (PSA) test. These tests will help find out if you have prostate cancer or if your prostate cancer has come back.

Your doctor also may do a biopsy. In this test, your doctor takes a sample of tissue from your prostate gland or from the area where the cancer may have spread and sends the sample to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.

If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or MRI to see if it has come back or spread.

Finding out that you have cancer can be scary. It may help to talk with your doctor or with other people who have had cancer. Your local American Cancer Society chapter can help you find a support group.

How is it treated?

Choosing treatment for prostate cancer can be confusing. Your choices depend on your overall health, how fast the cancer is growing, and how far it has spread.

Locally advanced prostate cancer may be treated with surgery, radiation therapy, or hormone therapy.

Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, or chemotherapy.

Frequently Asked Questions

Learning about prostate cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with prostate cancer:

End-of-life issues:

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Cause

The exact cause of prostate cancer is not known, but experts believe your age and family history may have something to do with your chances of getting the disease. Prostate cancer is very common and is an older man's disease. Most men who get it are older than 65.

Symptoms

Prostate cancer may not cause noticeable symptoms. Possible symptoms of locally advanced prostate cancer are:

  • Urinary problems, such as:
    • Not being able to urinate at all.
    • Having a hard time starting or stopping the flow of urine.
    • Having to urinate often, especially at night.
    • Having pain or burning during urination.
  • Difficulty having an erection.
  • Blood in your urine or semen.
  • Deep and frequent pain in your lower back, belly, hip, or pelvis.

These symptoms also may be caused by:

  • Benign prostatic hyperplasia (BPH), which is an enlarged prostate. This is very common in older men. The prostate usually grows larger with age. When it gets large enough, it can press against the urethra and cause urination problems.
  • Prostatitis, an infection in the prostate.
  • Urinary tract infection, an infection in any of the organs and tubes that process and carry urine out of the body.

Symptoms that may indicate the cancer has spread to other parts of the body, or metastasized, include:

  • Weight loss.
  • Bone pain.
  • Swelling in the legs and feet.

What Happens

Prostate cancer is a common cancer affecting older men. About 17 out of 100 men living in the United States will get prostate cancer. Out of these 17 men, 3 will die of prostate cancer. This means that 97 out of 100 men will die from something other than prostate cancer.1

It usually is a very slow-growing cancer that takes years to grow large enough to cause any symptoms. In some men, it never does cause problems. Sometimes, though, it grows quickly and may cause complications or death.

When prostate cancer grows large enough, it begins to fill the prostate and often can be felt by your doctor during a digital rectal exam. As it continues to grow, it breaks through the outer rim of the prostate and into nearby tissues, such as the seminal vesicles. At this point, the disease is called locally advanced prostate cancer.

Locally advanced prostate cancer is usually not curable. But there are treatments that can help you live longer and feel better. Most men live up to 5 years after this diagnosis, but some men may live longer.2

After the cancer has broken through the prostate, it may move into nearby lymph nodes. From the lymph node system, the cancer can spread to other areas of the body. Most often, prostate cancer spreads to the bones. It also may spread to the lungs or other organs. When it has spread to the lymph nodes, the disease is called metastatic prostate cancer.

Metastatic prostate cancer is not curable. But a number of treatments are available to help you live longer and make you feel better. Most men live 1 to 3 years after this diagnosis, but some men may live many years longer.2

What Increases Your Risk

A risk is anything that makes you more likely to get a particular disease. Being older than 50 is the main risk for prostate cancer. At least 6 out of 10 new prostate cancers are diagnosed in men who are 65 and older.3

Your chances of getting the disease are higher if other men in your family have had it. Your risk is doubled if your father or brother developed prostate cancer. Your risk also depends on the age at which your relative was diagnosed. Most men who get prostate cancer have no family history of the disease.

Race and prostate cancer

African-American men and Jamaican men of African descent have a greater chance of developing the kind of prostate cancer that grows and spreads. Researchers are not sure why there is a difference in disease and death rates among different races. Some experts think there may be a genetic link.4

When To Call a Doctor

Call your doctor immediately if you:

  • Are completely unable to urinate.
  • Have painful urination and a fever higher than 100°F (37.78°C), chills, or body aches.
  • Have blood or pus in your urine or semen.

Call your doctor to schedule an appointment if you have unexplained:

  • Weight loss.
  • Dull, aching pain in your lower back, pelvis, or hips.
  • Swollen lymph nodes in the groin area. These nodes are usually not tender.

Active surveillance

Active surveillance (watchful waiting) may mean not trying to get rid of the cancer. If an older man has serious health problems and isn't expected to live long, he may not be able to handle treatments or even want to have treatments except those needed to keep him comfortable (palliative care).

But active surveillance sometimes means a man will be watched closely by his doctor and have regular checkups. If the cancer starts to grow more quickly, he will have other treatment.

Active surveillance may not be a choice when prostate cancer has spread.

Sometimes men who have PSA levels that are rising slowly after having treatment may not start hormone treatments right away but be monitored with active surveillance.

Who to see

Doctors who can treat locally advanced and metastatic prostate cancer include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Locally advanced and metastatic prostate cancer are diagnosed through physical exams and tests, including:

  • A digital rectal exam, in which the doctor inserts a gloved finger into your rectum to feel your prostate gland. Some prostate tumors can be found this way.
  • A PSA test to measure the levels of prostate-specific antigen (PSA) in your blood. A higher level of PSA may indicate an enlargement, infection, or cancer of the prostate. A rising PSA level after treatment for prostate cancer can mean your cancer has come back.
  • A urine test, in which some of your urine is sent to a lab and checked for blood or infection. Prostate cancer can cause blood in the urine.
  • A prostate biopsy, in which tissue is taken from your prostate and examined under a microscope. The other exams and tests can give clues that you may have prostate cancer, but only a prostate biopsy can tell for sure.

If you have had prostate cancer before, one or more tests will help your doctor see if your cancer has come back or spread. These may include:

  • Blood tests. Different types of blood tests are used to see whether cancer has spread to your bones or liver.
  • A bone scan. Radioactive material that shows up on X-rays is injected into your arm. An X-ray camera passes over your body, taking pictures as the radioactive material moves into your bones. Areas of bone damage show up in the pictures. Prostate cancer that has spread to the bones can cause this kind of damage.
  • A CT scan. A CT scanner directs a series of X-ray pulses through your body. Each X-ray pulse lasts only a fraction of a second and represents a “slice” of the organ or area being studied.
  • An MRI. An MRI uses a strong magnetic field to make pictures of the prostate. This can show tissue damage or disease, such as infection or a tumor.
  • ProstaScint scan. Radioactive material that is absorbed by prostate cancer cells and shows up on X-rays is injected into your vein. Four days after the injection, your body is scanned with a special camera, and lymph nodes and other areas that have been invaded by prostate cancer cells show up on the scanning image.

Follow-up checkups

If you have been treated for prostate cancer in the past, you've probably been having regular checkups that include PSA tests to check for any signs that the cancer has come back or has spread to other parts of your body. Your doctor will watch for any increases in your PSA level and the speed with which any increases occur. A higher PSA does not necessarily mean your cancer has come back. But it may mean that you need further tests, such as a prostate biopsy, bone scan, CT scan, or MRI.

Treatment Overview

Choosing treatment for prostate cancer can be confusing. Any treatment probably will cause serious side effects. It's important to learn all you can about your choices and talk to your doctor about them.

Your treatment options will depend on:

  • What kind of cancer cells you have. This is called the grade or Gleason score of your cancer. Some prostate cancer cells grow more quickly than others.
  • Your age.
  • Any serious health problems you might have, including urinary, bowel, or sexual function problems.
  • Your PSA level.

Treatment for locally advanced or metastatic prostate cancer may include hormone therapy, surgery, radiation therapy, and chemotherapy. You may want to talk with your doctor about entering a clinical trial of new cancer treatment options.

Some treatments being studied in clinical trials for advanced prostate cancer include ultrasound-guided cryosurgery, proton beam radiation, mixed beam radiation, and high-intensity-focused ultrasound (HIFU). For metastatic prostate cancer, treatments in clinical trials include new forms of chemotherapy and immunotherapy, including vaccines.

Prostate cancer and its treatment may cause nausea, pain, or other side effects. You can manage some side effects at home. If you experience nausea, wait for 1 hour after vomiting has stopped and then sip a rehydration drink to restore lost fluids and nutrients. Your doctor also may prescribe medicines to control nausea and vomiting. Constipation and diarrhea may be eased if you drink enough fluids.

Pain from cancer that has spread to the bones can be managed. If pain becomes a problem, talk to your doctor about seeing a pain management specialist. For tips on handling pain, see:

Click here to view an Actionset. Cancer: Controlling Cancer Pain.

For more information, see the topic Cancer Pain.

Localized prostate cancer is cancer that has not spread outside the prostate. For more information on treatment of localized prostate cancer, see the topic Prostate Cancer.

Treatment for locally advanced prostate cancer

Prostate cancer that has spread to tissue around the prostate may be treated with:

  • Radiation therapy. This treatment uses high-energy X-rays or protons to destroy the cancer. Radiation treatments, both external and internal radiation, have been improved with newer technologies, so there are fewer side effects and complications than in the past. Radiation therapy usually is combined with hormone therapy.
    • External radiation. Also called external beam radiotherapy, or EBRT, radiation therapy uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. For men with locally advanced cancers, ERBT may be given along with brachytherapy. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may cause your symptoms to get worse. The two most common forms of external radiation are listed below:
      • Conformal radiotherapy (3D-CRT) uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
      • Intensity modulated radiation therapy (IMRT) uses newer 3D-CRT technology to target the cancer.
  • Surgery.
    • Radical prostatectomy. This operation takes out your prostate gland and the cancer in and around it. After surgery, men usually are started on hormone therapy.
    • Transurethral resection of the prostate (TURP). This surgery can help relieve bladder problems, because it removes part of the tumor that may be blocking the urethra, the tube that carries urine from your bladder through your penis. The procedure is done under general anesthesia. This can keep the tumor from growing for a while. But TURP does not take out the whole tumor.
  • Hormone therapy, also called androgen deprivation therapy (ADT). Prostate cancer needs male hormones (testosterone) in order to survive. Hormone therapy decreases the amount of testosterone and other male hormones in your body. This often causes tumors to shrink. Shrinking the tumors can ease severe bone pain caused by the spread of cancer to the bones. Hormone therapy usually is combined with radiation therapy. The most common methods are:
    • LH-RH agonists and GnRH agonists. These drugs, such as goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar), stop the body from making testosterone.
    • GnRH antagonists. These drugs stop the body from making testosterone. They work right away and avoid the flare caused by GnRH agonists that can make symptoms worse for several weeks. One GnRH antagonist is degarelix (Firmagon).
    • Antiandrogens. These drugs, such as bicalutamide (Casodex), often are used along with LH-RH agonists. Antiandrogens help block the body's supply of testosterone.
    • Orchiectomy. This is surgery to remove the testicles, which produce more than 90% of the body's male hormones (androgens), including testosterone.

In some cases, men will have radiation therapy after a prostatectomy, especially if the tumor could not be completely removed by surgery.

Some men choose to start hormone therapy only after they have symptoms. But many doctors recommend starting hormone therapy right away if cancer is found in the lymph nodes during surgery to remove the prostate. Early treatment may allow men to live a little longer. Other doctors say to wait, because waiting delays the bothersome and serious side effects of hormone therapy.

Treatment for metastatic prostate cancer

Treatment for prostate cancer that has spread to the bones and/or other organs in the body is aimed at relieving symptoms and slowing the cancer's growth. Treatment may include:

Hormone therapy works by decreasing the amount of testosterone in your body. This can be done with medicine or with surgery to remove the testicles (orchiectomy). Hormone therapy can also relieve pain by shrinking tumors and easing urinary problems.

Sometimes androgen deprivation (orchiectomy or an LH-RH agonist) and an antiandrogen are used together. This is called a combined androgen blockade (CAB). But the slight benefit of CAB may be offset by side effects.

Both orchiectomy and hormone therapy medicine make testosterone levels drop, causing some of the same side effects. These include larger breasts, hot flashes, loss of sexual desire, and the inability to have an erection. Treatment options for these problems include:

  • Taking a temporary break from hormone therapy. This can make some side effects go away. (Side effects after orchiectomy are permanent.)
  • Radiation treatment of the breasts to prevent breast growth. This is done before starting hormone therapy.
  • Radiation treatment or the anti-estrogen breast cancer medicine called tamoxifen to relieve breast pain. Tamoxifen can also help reverse breast growth. It also causes hot flashes.
  • Taking medicines to control hot flashes, such as venlafaxine or paroxetine. If these don't work, sometimes estrogen or megestrol may help reduce hot flashes. But all of these medicines have different side effects, so if you are having a problem with hot flashes, talk with your doctor.

Other serious side effects of hormone therapy may include thin or brittle bones (osteoporosis), reduced muscle mass, increased body mass (BMI), low red blood cell counts (anemia), fatigue, cognitive impairment (trouble thinking clearly), depression, and an increased risk for diabetes and heart disease.

Hormone therapy usually works well at first to stop cancer growth. But in most cases the cancer returns in a few years. At this point, the cancer is described as hormone-resistant, meaning it is not responding to standard hormone therapy. When this happens, other kinds of hormone treatment may be tried. If the cancer continues to grow, chemotherapy may be recommended.

Other hormone therapies may include the use of medicines such as megestrol acetate, estrogen, ketoconazole, aminoglutethimide combined with hydrocortisone, and corticosteroids (prednisone, dexamethasone, and hydrocortisone).

Some men choose to start hormone therapy only after they have symptoms. But many doctors recommend starting hormone therapy right away if cancer is found in the lymph nodes during surgery to remove the prostate. Early treatment may allow men to live a little longer. Other doctors say to wait, because waiting delays the bothersome and serious side effects of hormone therapy.

Alternatives to conventional hormone therapy include intermittent ADT, known as IAD, where men take cycles of hormone therapy medicines. Taking breaks between hormone therapy cycles gives men the chance to recover their ability to function sexually. It also gives relief from the other side effects of hormone therapy, including the loss of energy, loss of bone and muscle mass, and hot flashes. The long-term survival outcome of IAD compared to conventional ADT is not yet known, but from early studies, it looks like they both work about the same.5

For more information about specific treatments, see the following topics:

What to think about

You may experience a wide variety of emotions after being diagnosed. Most men feel some denial, anger, and grief. Others feel nothing at all. It is normal to have a wide range of feelings. And it is normal for your feelings to change quickly. There are many things you can do to help with your emotional reaction to prostate cancer. You may find that talking with family and friends helps you with your emotions. Some men find that spending time alone is what they need.

If your reaction is interfering with your ability to make decisions about your health, be sure to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also ask your local chapter of the American Cancer Society to help you find a support group. Talking with other men who have had similar feelings can help a lot.

Long-term hormone therapy can also lead to osteoporosis, which causes bones to become brittle and more likely to break. Drugs are available to help prevent this side effect. For more information, see the topic Osteoporosis.

There are many studies (clinical trials) focusing on finding ways to prevent, detect, diagnose, and treat prostate cancer in all stages. Talk to your doctor about whether entering a clinical trial is a good option for you to explore.

Palliative care

If your cancer gets worse, look into your options for palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from trying to cure your illness. Palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit. Some people combine palliative care with curative care.

With prostate cancer, palliative care may involve treatments to reduce tumors or bone pain, such as chemotherapy, radiation therapy, radionuclides (medicine used in external radiation) for bone metastasis, and bisphosphonates, which slow the breakdown of bone and help relieve bone pain. Surgery to relieve bladder problems (transurethral resection of the prostate, or TURP) is also an option.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans around your medical care, or help your family better understand your illness and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

You may wish to discuss health care and other legal issues that arise near the end of life with your family and your doctor. You may find it helpful and comforting to state your health care choices in writing—with an advance directive or living will—while you are still able to make and communicate these decisions.

Think about your treatment options and which kind of treatment will be best for you. You may want to choose a health care agent to make and carry out decisions about your care if you should become unable to speak for yourself. Be sure to share your wishes with your family or close friends. You can get forms from Caring Connections (www.caringinfo.org or 1-800-658-8898) or Aging With Dignity (www.agingwithdignity.org or 1-888-594-7437).

For more information, see the topic Care at the End of Life.

Hospice care provides medical services, emotional support, and spiritual resources for people who are at the end of life. Hospice care also helps family members manage the practical details and emotional challenges of caring for a dying loved one. For more information, see the topic Hospice Care.

Prevention

Prostate cancer can't be prevented. But there are steps you can take to reduce your risk of developing this disease. For more information, see the topic Prostate Cancer.

Home Treatment

During medical care for any stage of prostate cancer, there are things you can do at home to help manage symptoms of prostate cancer or side effects of treatment:

  • Nausea or vomiting. After vomiting has stopped for 1 hour, sip a rehydration drink to restore lost fluids and nutrients. Watch for and treat early signs of dehydration. Older adults can quickly become dehydrated from vomiting. Your doctor may also prescribe medicines to control nausea and vomiting. For more information on how to deal with these side effects, see:
    Click here to view an Actionset. Cancer: Controlling Nausea and Vomiting From Chemotherapy.
  • Pain. For pain, talk to your doctor about using aspirin, acetaminophen (such as Tylenol), or another type of nonsteroidal anti-inflammatory drug (NSAID). Or ask about a narcotic medicine. You can also try an alternative therapy such as biofeedback. Be sure to discuss with your doctor any home treatment you use for pain.
  • Diarrhea. Don't eat until you are feeling better. Take frequent, small sips of water or a rehydration drink and small bites of salty crackers. Begin eating mild foods (such as rice, dry toast or crackers, bananas, broth, and applesauce) the next day or sooner, depending on how you feel.
  • Constipation. Make sure you drink enough fluids. Most adults should drink between 8 and 10 glasses of water or noncaffeinated beverages each day. Include fruits, vegetables, and fiber in your diet each day.
  • Sleep problems. Often, simple measures such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day can relieve sleep problems.
  • Urinary problems. Home treatment for urinary incontinence includes eliminating caffeinated drinks from your diet and establishing a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need. You may also try doing pelvic floor (Kegel) exercises to strengthen your pelvic muscles.

During medical treatment for prostate cancer, you may experience emotional problems. See the following tips for managing:

  • Stress. Expressing your feelings to others may help you understand and cope with them. Learning relaxation techniques may also be helpful.
  • Poor body image. Your feelings about your body may change after treatment for cancer. Talk openly about your concerns with your partner. And discuss your feelings with your doctor, who may also be able to refer you to groups that can offer support and information.

Pain from cancer or its treatments can almost always be managed. If pain becomes a problem, talk to your doctor about seeing a pain management specialist. For tips on pain management, see:

Click here to view an Actionset. Cancer: Controlling Cancer Pain.

For more information, see the topic Cancer Pain.

Medications

Medicines may be used to slow the growth of prostate cancer and to relieve your symptoms.

Prostate cancer needs the male hormone testosterone to grow. Hormone therapy uses special drugs to block the production or action of testosterone and may cause the cancer to shrink. This can improve your symptoms. Hormone therapy may be given before or after radiation or surgery to remove the prostate.

Chemotherapy is the use of drugs to control cancer's growth or relieve pain. Often the drugs are given through a needle in your vein, and your blood vessels carry the drugs through your body. Sometimes the drugs are available as pills you can swallow. Sometimes they are given through a shot, or injection.

Chemotherapy usually involves two or more drugs given together. This is done to lower the chances that the cancer cells will become resistant to the drugs. It is most often used when prostate cancer is hormone-resistant.

Hormone therapy usually works well at first to stop cancer growth. But in most cases the cancer returns in a few years. At this point, the cancer is called hormone-resistant. This means it will no longer get better with hormone therapy. When this happens, other kinds of hormone treatment may work. If the cancer continues to grow, chemotherapy may be the next choice.

Medication Choices

Hormone therapy

  • LH-RH agonists/GnRH agonists, such as leuprolide (Lupron) and goserelin (Zoladex)
  • GnRH antagonists, such as degarelix (Firmagon).
  • Antiandrogens, such as flutamide, nilutamide (Nilandron), and bicalutamide (Casodex)

Hormone therapy for prostate cancer also includes orchiectomy, which is the surgical removal of the testicles. Hormone therapy is commonly used with radiation therapy. It may be used alone with metastatic cancer.

Chemotherapy

Chemotherapy may be helpful when prostate cancer no longer responds to hormone therapy.

Pain-relief and appetite-stimulant drugs

Pain-relief and appetite-stimulant drugs may be used when prostate cancer has spread to other parts of the body.

  • Steroids, such as hydrocortisone or prednisone, control pain and improve appetite.
  • Radioactive drugs such as strontium-89 and samarium-153 are called radionuclides. They are absorbed near the area of bone pain. Then the radiation that is released helps relieve the pain caused by tumors that have spread to the bone.
  • Bisphosphonate drugs such as zoledronic acid (Zometa) and pamidronate disodium (Aredia) may help relieve bone pain and prevent osteoporosis, which is sometimes caused by long-term hormone therapy.

Pain medicines are made that specifically treat mild, moderate, and severe pain, as well as different types of pain such as burning and tingling. To learn more, see:

Click here to view an Actionset. Cancer: Controlling Cancer Pain.

For more information, see the topic Cancer Pain.

Medicines for treating side effects

Hormone therapy can cause loss of sexual desire, hot flashes, enlarged and painful breasts, and erection problems.

  • For men who have erectile problems after surgery, medicines such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) may be helpful. Using medicines soon after surgery may help men regain sexual function. Talk with your doctor about your situation.
  • Taking a temporary break from hormone therapy can make some side effects go away.
  • To relieve breast pain, the anti-estrogen breast cancer medicine called tamoxifen or radiation treatment is commonly used. Tamoxifen can also help reverse breast growth. It also causes hot flashes.
  • For hot flashes, taking a certain kind of antidepressant may help. Venlafaxine or paroxetine may help with hot flashes. But they have different side effects. So if you are having a problem with hot flashes, talk with your doctor.

What to Think About

Antiandrogen hormone therapy also may cause diarrhea, breast tenderness, and nausea. Cases of liver problems, some serious, have been reported.

When surgery or hormone therapy reduces the body's hormones, the bones may begin to lose their mineral density. Bone mineral density refers to how many minerals—which make your bones stronger—are in your bones. Bones that become thin and brittle are more likely to break, and studies show that hormone therapy increases the likelihood of broken bones.6 Pills or shots of a medicine called bisphosphonate can help prevent bone loss during long-term hormone therapy. These medicines may also help men whose prostate cancer has spread to the bones. Regular exercise also helps. For more information, see the topic Osteoporosis.

Surgery

Surgery to treat prostate cancer is usually reserved for men in good health who are younger than 70 and who choose to have surgery. Surgery may be done to relieve symptoms and to slow the growth of cancer.

Surgery Choices

  • Radical prostatectomy, the removal of the prostate and its cancer. It is not usually done if the cancer has spread to other parts of the body.
  • Orchiectomy, the removal of the testicles. This may cause the cancer to shrink and may improve symptoms because prostate cancer often needs the testosterone made by the testicles to grow.
  • TURP, or transurethral resection of the prostate. This operation can help to relieve bladder problems because it removes part of the tumor that may be blocking the urethra, the tube that carries urine from your bladder through your penis. This can keep the tumor from growing for a while. But TURP does not take out the whole tumor.

What to Think About

Surgical removal of the testicles (orchiectomy) and hormone therapy medicines have some of the same side effects, including hot flashes, larger breasts, loss of sexual desire, and the inability to have an erection.

Other Treatment

Radiation therapy

Radiation therapy for prostate cancer may be used alone or combined with hormone treatment. In rare cases, it is used with surgery. It is most effective in treating cancers that have not spread beyond the prostate, but it can also be effective in treating cancer that is only in the tissue near the prostate (locally advanced prostate cancer). Radiation therapy also is used to relieve pain from metastatic cancer or cancer that comes back after surgery.

Radiation therapy for locally advanced prostate cancer is often combined with hormone treatment. Using both together improves your chances of being disease-free for longer and living longer.2

External-beam radiation therapy uses a large machine to aim a beam of radiation at your tumor to destroy cancer cells. The radiation damages the genetic material of the cells so that they can't grow. Although radiation damages normal cells as well as cancer cells, the normal cells can repair themselves and function, while the cancer cells cannot. If cancer has spread to your bones, radiation treatment may be given to specific areas to relieve pain.

Side effects

Radiation treatment commonly has side effects, including urinary incontinence, inflammation of the bladder and colon (colitis), diarrhea, and erection problems.

Side effects are common. Some men develop long-term problems that may have a significant impact on the quality of their lives. Long-term problems that can be caused by radiation treatment include:

  • An irritated rectum and an urgent need to pass a stool. This is called proctitis.
  • An inflamed bladder and urination problems. This is called cystitis.
  • An inflamed intestine and diarrhea. This is called enteritis.
  • Being unable to have an erection. This is called impotence.
  • Being unable to control urination. This is called incontinence.
  • Painful urination. This is called dysuria.

Immunotherapy

Researchers also are testing many new ways to treat prostate cancer using the body's immune system to destroy the cancer cells. This type of treatment is called immunotherapy. Much has been learned in the past 20 years about the body's ability to attack prostate cancer cells with help from the outside. And research is still being done in this area. This type of treatment either stimulates your immune system or adds to it, for example, by giving you immune cells from another person.

Vaccines such as Provenge use cells from a man's own body to stimulate his immune system. This can slow the growth of prostate cancer.

Complementary therapy

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

Mind-body treatments like those mentioned above may help you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain, headaches, and pain from cancer treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Clinical trials

You may be interested in taking part in research studies called clinical trials. Clinical trials are designed to find better ways to treat prostate cancer patients and are based on the most up-to-date information. People who do not want standard treatments or are not cured by standard treatments may want to take part in clinical trials.

Check with your doctor to see whether clinical trials are in your area and whether you might be eligible.

Other Places To Get Help

Organizations

Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA  30333
Phone: 1-800-CDC-INFO (1-800-232-4636)
TDD: 1-888-232-6348
Email: cdcinfo@cdc.gov
Web Address: www.cdc.gov
 

The Centers for Disease Control and Prevention (CDC) is an agency of the U.S. Department of Health and Human Services. The CDC works with state and local health officials and the public to achieve better health for all people. The CDC creates the expertise, information, and tools that people and communities need to protect their health—by promoting health, preventing disease, injury, and disability, and being prepared for new health threats.


National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


Prostate Cancer Foundation
1250 Fourth Street
Santa Monica, CA 90401
Phone: 1-800-757-CURE (1-800-757-2873)
(310) 570-4700
Fax: (310) 570-4701
Email: info@pcf.org
Web Address: www.prostatecancerfoundation.org
 

The Prostate Cancer Foundation is the world's leading organization for funding prostate cancer research. On its Web site, you'll find information on prostate cancer detection, treatment, and support groups.


UrologyHealth.org, American Urological Association
1000 Corporate Boulevard
Linthicum, MD  21090
Phone: 1-866-RING AUA (1-866-746-4282) toll-free (U.S. only)
(410) 689-3700
Fax: (410) 689-3800
Email: auafoundation@auafoundation.org
Web Address: www.urologyhealth.org
 

UrologyHealth.org is a Web site written by urologists for patients. Visitors can find specific topics by using the "search" option.

The Web site provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology Resource Center to find materials about urologic problems.


Related Information

References

Citations

  1. Zelefsky MJ, et al. (2008). Cancer of the prostate. In VT DeVita Jr et al., eds., Devita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1392–1452. Philadelphia: Lippincott Williams and Wilkins.
  2. National Cancer Institute (2010): Prostate Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.nci.nih.gov/cancertopics/pdq/treatment/prostate/healthprofessional.
  3. American Cancer Society (2009). Cancer Facts and Figures 2009. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@nho/documents/document/500809webpdf.pdf.
  4. Robbins C, et al. (2007). Confirmation study of prostate cancer risk variants at 8q24 in African Americans identifies a novel risk locus. Genome Research, 17(12): 1717–1722.
  5. Tunn U (2007). The current status of intermittent androgen deprivation (IAD) therapy for prostate cancer: Putting IAD under the spotlight. British Journal of Urology International, 99(Suppl 1): 19–24.
  6. Shahinian VB, et al. (2005). Risk of fracture after androgen deprivation for prostate cancer. New England Journal of Medicine, 352(2): 154–164.

Other Works Consulted

  • Foley KM, Abernathy A (2008). Management of cancer pain. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 2757–2790. Philadelphia: Lippincott Williams and Wilkins.
  • Kantoff PW (2007). Prostate cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 9. New York: WebMD.
  • Loblaw DA, et al. (2007). Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. Journal of Clinical Oncology, 25(12): 1596–1605.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology
Last Revised March 1, 2011

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