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Do What You Can to Ease Side Effects of Treatment for Localized Prostate Cancer

It's likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. The side effects depend on your treatment, and that depends on how much the cancer has spread from your prostate. In this section, you'll learn more about how to respond to some of the most common side effects and symptoms from early-stage prostate cancer. Prostate cancer in its early stages is cancer that hasn't spread too far from the prostate, also called localized cancer.

If you have cancer that is confined to the prostate or that has spread only to areas near your prostate, you may have surgery or internal or external radiation treatments. We've listed some common side effects from these treatments and how to ease them. They are listed in alphabetical order so you can find help when you need it.

Anxiety and Depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back during treatment.

Taking these actions may ease your mental stress.

  • Talk with your family or friends.

  • Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

  • Ask your doctor about medications for depression and anxiety.

Diarrhea

Diarrhea includes loose or frequent bowel movements, or both. It may be a side effect of external radiation therapy. Many drugs can cause bowel changes, too. Diarrhea may lead to dehydration if you don't take these precautions.

  • Avoid milk and milk products.

  • Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

  • Eat low-residue, low-fiber foods such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

  • Drink more fluids, such as water and broth, to prevent dehydration.

  • Ask your doctor about medications that may help.

Pain

You may have pain from the cancer itself, from surgical incisions, or from bladder irritation. Try these tips to ease the pain.

  • Take your pain medications regularly; don't wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

  • Change your activity level. See if you feel better if you rest more or move around more--either may help.

  • Distract yourself with music, funny videos, or computer games.

  • Use relaxation techniques, such as yoga or meditation, or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Rectal Pain

This can be from the surgery, from internal or external radiation, or from cryosurgery. Take these steps to ease the pain.

  • Take a warm sitz bath. Try two baths a day, each about 15 minutes long.

  • Talk with your doctor about creams or suppositories you can use.

Sexual Problems: Impotence, Erectile Dysfunction

The inability to have an erection can be a short-term or long-term side effect of treatment for prostate cancer. Basically, all the treatments for prostate cancer carry a risk for impotence. They differ in how soon after treatment it may occur and how likely it is to occur. The psychological stress of coping with cancer can also affect your ability to have sex. Before treatment, ask your doctor what you can expect. Knowing what to expect may help you cope.

The risk of impotence based on treatment. Here's an overview of different treatments for localized prostate cancer and their risk and incidence of impotence.

  • Radical prostatectomy. Impotence from this treatment can occur because the nerves that are involved in erections are either damaged or removed by surgery. The incidence of impotence varies with age, sexual function before surgery, and whether your doctor is able to do a nerve-sparing procedure. When impotence occurs, it happens immediately after surgery. If you have impotence after a nerve-sparing surgery, your ability to have erections may return within a year.

  • External radiation. Impotence from this treatment is due to radiation damage to the arteries that carry blood to the penis. The dysfunction occurs a year or more after the radiation. The risk for impotence is greater two to five years after radiation than it is within the first year.

  • Interstitial seed therapy. The dysfunction tends to occur later, months to years after treatment.

 To help you cope with these changes, take these actions.

  • Talk with your partner about changes in your ability to have sex.

  • Explore new ways to share affection and intimacy.

  • See a counselor who specializes in sexual problems.

  • Talk about it with your doctor and other members of your health care team. They may be able to refer you to a sexual rehabilitation program.

  • Talk with your doctor about medical ways to restore erections. Your options may include medications, such as Viagra; penile implants; injections; or vacuum devices.

  • If childbearing is an issue, talk with your doctor about this before your treatment. There may be ways to store sperm in a bank.

Swelling

You may have bruising or swelling of the scrotal area from the needles in internal radiation therapy. Here are some ways to ease swelling.

  • Place an ice pack over the area for as long as it's comfortable for the first 24 hours after the procedure.

  • Take a warm sitz bath.

  • Take pain medicine to ease pain as directed by your doctor.

Urinary Problems

Since the prostate is around the urethra, the tube that carries urine through the penis and out of the body, treating prostate cancer, especially with localized cancer, can cause problems with urination.

Types of problems that may occur. Here are some of the problems that may occur.

  • Painful urination, called dysuria

  • Frequency problems. You may feel like you have to urinate all the time.

  • Hesitancy problems. You may not be able to start the flow of urine even when you feel like you need to go.

  • Frequently urinating at night, called nocturia. You may wake up feeling like you need to urinate, but then are not able to.

  • Leaking urine during a sudden increase in abdominal pressure, such as with coughing, sneezing, laughing, or picking up heavy objects. This is called stress incontinence. It results from radical prostatectomy. It may also occur after seed therapy, especially if you also had a transurethral resection of the prostate (TURP).

  • Leaking urine before you can get to the bathroom, called urge incontinence. This may also occur after a radical prostatectomy, but it's not as common as stress incontinence.

  • Feeling like you can't empty your bladder when you urinate or a weak flow of urine, called overflow incontinence. This is common in men who have had external beam radiation treatment (EBRT). It also sometimes occurs in men who have had a radical prostatectomy or interstitial seed therapy.

These problems can result from surgery, internal and external radiation, and cryotherapy. Sometimes they are temporary. For instance, with external radiation, urinary problems often don't start until about three to five weeks into the treatment. Then, they may stop two to eight weeks after treatment has ended. Sometimes they are permanent.

Tips for coping with urinary problems. Not being able to control your urine can lead to anxiety, hopelessness, and loss of self-control or self-esteem. Take heart. There are treatments available. Start with these steps.

  • Talk with your partner about how you feel if your fear of incontinence is limiting your participation in sex or social activities.

  • Talk with your doctor about prescription drugs that may decrease urinary frequency.

  • Keep track of your symptoms so that you can let your doctor know exactly what is happening. Record how many incontinence pads you use, what activities cause incontinence, how frequently you urinate, if you have frequency or urgency, how strong your force of urine stream is, if you feel that you are emptying your bladder well, and what types and how much fluid you are drinking.

  • Make sure you urinate regularly--about every three hours.

  • Avoid drinking caffeinated beverages because caffeine causes the kidneys to make more urine and irritates the bladder.

  • It may help to avoid acidic foods, such as orange juice, and spicy foods because they may irritate the bladder.

  • Talk with your doctor about how to do Kegel exercises to help with stress incontinence. These exercises strengthen the pelvic floor muscles. Here's how to identify these muscles. Try stopping your urine stream while you are urinating. The muscle you use is the one you want to strengthen. To perform Kegel exercises, simply repetitively contract and relax that muscle at least 20 times every day. These exercises are the most helpful when the catheter is removed after radical prostatectomy. They are not as effective in men who have had radiation treatment.

  • Talk with your doctor about your options for treatment. These may include medications, catheterization, and other options.