Side Effects of Prostate Cancer Therapy

Since some men are more likely to die with prostate cancer than because of it, the issue of side effects is essential to making a decision about treatment. You might be willing to tolerate a higher level of collateral damage when the therapy is a matter of life and death. But when the life-saving benefits are less certain, the trade-offs become harder to justify.

Plus, it’s hard to know until treatment kicks in which side effects you will experience and how bad they might be. Studies have found that cer tain factors increase the risk of side effects, such as obesity, a large prostate and a higher PSA level. Older men also tend to do worse over time than younger men.

Some side effects of treatment will go away shortly after the treatment stops, while some might persist for months or years, and some may never go away. Fertility will almost certainly be impacted. Here are side effects of some of the most common treatments:

Surgery

The prostate sits in tight quarters, surrounded on all sides by sensitive tissues. Surgery to remove the gland can damage nearby nerves and muscles. That means the two most serious, and dreaded, side effects of surgery—impotence and incontinence—are possible. If you experience either (or both) of these problems after treatment, the first message: Don’t panic. Many men commonly experience these side effects, only to have them resolve after several months.

The risk of impotence is smaller when doctors are able to remove the tumor without traumatizing the nearby nerves. The degree and speed of recovery is hard to predict because it depends on the level of function before the surgery, age and whether nerves were damaged; men with vascular problems or conditions, such as diabetes, tend to have a more difficult time regaining function. If the impotence persists, talk to your doctor about medical options.

Incontinence, too, tends to get better over time. A study published in 2008 in The New England Journal of Medicine found that, overall, urinary incontinence was at its worst two months after surgery but then started to improve. While about half the men who had their prostates removed reported daily bladder leakage two months after surgery, that number dropped to 14 percent two years later. If it persists, some drugs and other treatments might help. Your doctor can also tell you how to perform Kegel exercises to strengthen the muscles of your pelvic floor and to help with bladder control.

It's hard to know until treatment kicks in which side effects you will experience and how bad they might be.

Radiation

Radiation treatment can also lead to impotence and urinary problems for the same reasons—tumors can entrench themselves in nerves and muscles, which bear some of the radiation. Incontinence seems to occur more often in men treated with internal radiation or brachytherapy, which uses radioactive seeds that are implanted in the prostate gland, rather than external beam treatment. Since the prostate lies next to the rectum, it too can be a victim of friendly fire during radiation treatment. Damage to the rectum can lead to diarrhea and rectal bleeding, but these problems also tend to improve over time. While 16 percent of men in The New England Journal of Medicine study said they had bowel problems two months after receiving external beam radiation, the number was 11 percent after two years.

Few medical options exist to help manage diarrhea, but some men find their symptoms improve by making changes to their diet.

Hormone Therapy

The goal of hormonal therapy in prostate cancer treatment is to lower androgens, which include testosterone and dihydrotestosterone. The problem is, male hormones are normally quite busy throughout the body. The list of possible side effects from hormone deprivation is long and can be somewhat daunting: impotence, loss of sex drive, hot flashes, decrease in muscle mass, fatigue and even depression. Breast tissue may become larger, and bones could weaken. Men also may experience cardiovascular side effects, including an increase in cholesterol levels and weight gain, and be at an increased risk of hyper tension, diabetes, heart attack and stroke.

Every man will not suffer all of this. Which side effects occur and how severe they become depends on the drug and the patient. The estimates for any one problem vary widely. For example, one 2005 review of side effects found that incidences of impotence in studies varied from 50 to 100 percent.

Whether you experience one side effect or many, it’s hard to undergo hormone therapy scot-free. Doctors say the best way to manage side effects is to try to maintain as healthy a lifestyle as possible while taking the drugs; exercise, eat a good diet and get plenty of rest. If those measures aren’t helping—or aren’t helping enough—you can also talk to your doctor about prescriptions that may help. Antidepressants can help depression and mood; other drugs may strengthen bones. But hormone therapy typically only lasts a few months, and most of these side effects start to improve once you stop taking the drug.

If you have low-grade prostate cancer, or are older or have another serious illness, the quality of life you gain by watching and waiting may be worth the apprehension.

Chemotherapy

The side effects of chemotherapy in general are well known and include gastrointestinal problems, such as nausea, diarrhea and loss of appetite; increased risk of infection; mouth sores; hair loss; depression; fatigue; and neuropathy. The degree to which you will be affected depends on the dose, the drug combination and regimen.

Active Surveillance

Even if you choose active surveillance to avoid the side effects of other treatments, you may experience an unwanted side effect: the anxiety of living with untreated cancer. But if you have low-grade prostate cancer, or are older or have another serious illness, the quality of life you gain by watching and waiting may be worth the apprehension. New research shows that, in men with very low risk of disease progression, delaying prostate cancer intervention treatments for more than six years was a safe alternative.

The Bottom Line

Most prostate cancers are diagnosed when they are highly curable, but the cure may come with a price. Sometimes that price may be high. The best treatment should be decided on by you and your doctor, after considering factors like your age, the severity of the disease and your overall health. Take the time to make the best decision for you—in most cases, you’ll have that advantage.