In advanced prostate cancer, also known as stage IV, cancer has already spread to other parts of the body, outside the prostate gland. Men with advanced prostate cancer may experience a number of symptoms, including erectile dysfunction, bone pain, swelling in the legs, fatigue, and frequent infections, the Urology Care Foundation says. Although there is currently no cure for advanced or metastatic prostate cancer, there are ways to slow the spread, help you live longer, and control your symptoms, according to UCLA Health in Los Angeles. Treatment options can include immunotherapy, hormone therapy, chemotherapy, precision medicine, and clinical trials. It’s essential that you talk to your doctor about any symptoms you experience and discuss how to address them. Your doctor may also refer you to a palliative care specialist. Many people mistakenly believe that palliative care is a last resort or means that you are dying, according to the Prostate Cancer Foundation. In reality, palliative care helps you get the most out your life by helping manage pain, depression, anxiety, or any other issues you may be experiencing related to your cancer or treatment. Here are some of the most common symptoms of advanced prostate cancer, along with suggestions on how to manage them.
1. Pain
Pain in the hips, back (spine), chest (ribs), or other areas is common among men with advanced prostate cancer, particularly if the cancer has spread to the bones, according to ACS. There are a variety of medications available to help control pain. Some are taken by mouth and others through a patch on the skin, and some are administered intravenously. Treatments such as radiation therapy and surgery may be used to help relieve pain, the ACS says. Some complementary approaches such as acupuncture, healing touch, yoga, and biofeedback may also help manage pain, according to the Prostate Cancer Foundation. So it’s important, when the need arises, to see a pain specialist for help, as oncologists are specialists in cancer treatment but not necessarily pain management. Many hospitals have pain-relief experts who can tailor your treatment plan to address your exact symptoms. The pain you experience may also change during the course of your illness, so ask your care team to review your pain symptoms from time to time to be sure you are getting the best treatment. There are alternative therapies, also, that might help relieve pain, such as acupuncture, relaxation techniques, hypnosis, and massage. Ask your doctor if these approaches are appropriate for you. Certain cancer treatments, such as chemotherapy and radiation, can cause fatigue. Anxiety, stress, and changes in your diet or sleep patterns can make it worse. There are many steps you can take to manage fatigue, according to UCLA Health.
Rest, but don’t stay in bed or sit in chair for more than you need to. Too much rest can actually zap your energy.Try to add activity to your days. Although it may seem counterintuitive, moving more can give you energy.Keep a regular sleep schedule and don’t take long naps — keep them 40 minutes or less.Stay hydrated.Ask for help from a friend or family member with activities and chores that you find tiring or difficult to complete.Do light exercise if it feels helpful and your oncologist approves it — staying active can actually reduce fatigue and help you get better sleep.
In some cases, your fatigue may be the result of anemia, which can occur as a side effect of chemotherapy, UCLA Health says. Other than fatigue, symptoms of anemia may include dizziness, being very pale, headaches, shortness of breath, low blood pressure, and an elevated heart rate.
3. Loss of Libido and Erectile Dysfunction
The hormones that are often used to treat advanced prostate cancer can decrease libido and cause erectile dysfunction (ED), which occurs when a man isn’t able to have or keep an erection to have sex, according to the University of Rochester Medical Center in Rochester, New York. As a result, for couples, “there’s a real struggle to recover that sense of life together — how to be intimate without having sex,” says Michael J. Morris, MD, an oncologist at Memorial Sloan Kettering Cancer Center in New York City. Depending on the type of treatment that caused the ED, the ability to have an erection may improve over time, according to the University of Rochester Medical Center. You and your partner may want to explore other ways to be intimate in your relationship. A sex therapist or couples counselor may be able to help. There are also treatments available for erectile dysfunction, such as medications and implants.
4. Nausea and Vomiting
Nausea and vomiting are common side effects of cancer treatment, especially chemotherapy, according to UCLA Health. These conditions can make you feel tired and weak. Nausea can make it difficult for you to eat. If this is the case, try eating smaller meals five or six times a day and avoid foods that are sweet, fatty, spicy, or have strong smells. If nausea is causing you to throw up, there are antinausea medications called antiemetics that can help, UCLA Health says. You should also drink as much liquid as you can to keep your body from becoming dehydrated as you lose fluids. Water, broth, and clear soft drinks are good choices.
5. Loss of Appetite
Many men with advanced prostate cancer lose interest in food, have little appetite, and become unable to eat. Fatigue, pain, and changes in your senses of taste and smell can all contribute to a lack of appetite, according to ZERO: The End of Prostate Cancer, an advocacy organization devoted to eliminating prostate cancer. The organization offers the following tips to try to help you get the nutrition you need:
Try to take in more liquid through items like soup, tea, milk or milk substitutes, and sports drinks or by adding fresh fruit to your water.Add spices such as garlic, cayenne, dill, or rosemary to give your food more flavor.Eat several small meals throughout the day instead of just a few big meals.Get more protein from high-protein smoothies, fish, egg whites, cheese, or beans.
The ACS recommends trying high-calorie foods that are easy to eat, such as pudding, ice cream, or cream-based soups, doing light exercise an hour before meals to help stimulate your appetite, and drinking liquid food supplements to help fill you up when you don’t feel like eating. A nurse or dietitian can advise you on dietary changes that can optimize your health and your oncologist can prescribe medications to alleviate nausea and boost appetite.
6. Cognitive Impairment
Some people with advanced prostate cancer experience cognitive impairment or confusion, caused either by the cancer itself or by the medications used to treat it. Others with prostate cancer may have also had dementia that became more apparent after the diagnosis and treatment of prostate cancer, according to the Prostate Cancer Foundation. Signs of confusion include sudden changes in emotions, such as feeling calm and then suddenly very angry, research suggests. You may also have trouble paying attention or concentrating, or you might forget where you are or what day it is. If you experience this, you should notify your care team. Your doctor may decide to change your medication regimen, according to the Prostate Cancer Foundation. Brain “exercises” such as Sudoku or crossword puzzles may help.
7. Emotional Side Effects
In addition to physical symptoms and side effects, advanced prostate cancer can take a toll on your emotions. A diagnosis of advanced prostate cancer can leave you feeling anxious, overwhelmed, or depressed, according to the Prostate Cancer Foundation. While this is common, you shouldn’t ignore the signs that anxiety or depression is getting worse, as there are available treatments that can help. Signs of anxiety include an inability to stop worrying, persistent thinking that something terrible might happen, and an inability to sit still. Anxiety can also increase your risk for a panic attack, which causes symptoms such as feeling very tense, sweating, experiencing a racing heartbeat, having trouble catching your breath, feeling a lump in your throat, or experiencing sudden fear, the National Institute of Mental Health says. Loss of appetite, feeling hopeless or short-tempered, and sleeping too little or too much are potential signs of depression, according to the American Psychiatric Association. You might lose interest in what were once favorite activities or become unexpectedly tearful without warning. If you’re feeling any of these emotions, be sure to talk to your doctor, who can prescribe medication for anxiety and depression and might also recommend that you see a therapist to talk about your feelings.
