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Managing the side effects of prostate cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on July 25, 2022.

While many treatment options are used to treat prostate cancer, including surgery, radiation therapy, hormone therapy or chemotherapy, all prostate cancer treatments may cause side effects.

Some side effects may be short-term, while others may be permanent. Here’s how to manage the most common side effects of prostate cancer treatment.

Side effects from prostate cancer treatment

Nausea and vomiting

Certain prostate cancer treatments, including some types of radiation therapy and chemotherapies, may cause nausea and a queasy stomach. Vomiting is also possible.

If patients experience nausea and vomiting, they should talk to their care team about anti-nausea medications, including:

  • Antiemetic drugs
  • Steroids
  • Cannabinoids
  • Benzodiazepines

Beyond medication, nausea and vomiting may be managed at home. Bland foods like toast and crackers may help with nausea. Some patients find that certain foods don’t sound appealing when they’re feeling sick, so it’s fine to avoid those.

Frequent nausea may cause dehydration, so staying hydrated is important. This may involve drinking ginger ale and broth. An empty stomach may make nausea worse, so trying to keep down small snacks, especially before going for chemotherapy, may help.

Some behavioral health methods may also help with relaxation and help patients feel more in control when they’re nauseous, such as:

  • Hypnosis
  • Mindfulness
  • Acupuncture
  • Music therapy

Patients should always consult with a doctor before starting any of these types of treatments.

Fatigue

Both the mental and physical stresses of prostate cancer treatment may cause fatigue, which is also a common side effect of radiation therapy, chemotherapy and hormone therapy.

Patients should talk to their care team about fatigue and how they might help with fatigue treatment, to help identify patterns and what’s causing the tiredness. Medication may also be changed or adjusted to assist with fatigue. Besides medications, some activities that may help manage fatigue include:

  • Exercise
  • Yoga
  • Counseling
  • A nutritional plan that helps the patient get the vitamins and minerals they need

Planning the daytime schedule to allow for napping may also help to manage fatigue caused by prostate cancer radiation therapy.

Erectile dysfunction

Erectile dysfunction (ED), which is the inability to get or maintain an erection, is a common side effect associated with the surgical removal of the prostate, called a prostatectomy. ED may also occur during and after radiation therapy and hormone therapy.

While ED may be caused by physical changes to the body after treatment, it may also be the result of a reduced sex drive due to factors like changing hormone levels or psychological issues. In these cases, it may be helpful to seek out counseling.

The care team may also help with penile rehabilitation after a prostatectomy, including these erectile dysfunction treatment options:

  • Oral medications such as Viagra® (sildenafil citrate), which increase blood flow to the penis
  • Topical creams
  • Vacuum pumps
  • Penile injections
  • Implants

Urinary incontinence, retention and infection

After prostate cancer treatments such as surgery, radiation therapy and some types of chemotherapy, patients may experience urinary changes after prostate cancer, including:

  • Incontinence
  • Infection
  • A need to go more often

Men who experience these changes may undergo incontinence treatments, including:

  • Bladder training
  • Absorbent pads
  • Physical therapy
  • Oral medications
  • Surgery

Patients may also help avoid incontinence by limiting how much they drink (especially caffeine and alcohol), watching their weight, and going to the bathroom before bed and before exercising.

Diarrhea, constipation and bowel changes

In addition to urinary changes, some patients experience bowel changes after radiation therapy, chemotherapy or hormone therapy for prostate cancer, including:

  • Diarrhea
  • Constipation
  • Upset stomach

Bowel changes may be managed with digestive issues treatment options, including:

  • Medication
  • Dietary changes
  • Pelvic floor exercises, which may also help with incontinence
  • Bowel care plan

To avoid infection or irritation, some steps may include:

  • Washing or using wipes after going to the bathroom
  • Changing underwear often
  • Using moisture barrier creams to protect the anal area

Fertility

Because the prostate is part of the male reproductive system, some treatments may impact fertility, including:

Because a prostatectomy removes the prostate, which produces some of the seminal fluid that combines with sperm to make semen, it’s not possible to conceive a child naturally after surgery. Other treatments, like radiation therapy, may cause a reduced sperm count.

If patients plan to have children, they should let their care team know before beginning active treatment. They may be referred to a fertility specialist who may help with sperm banking, or they may choose a different treatment pathway.

Depression

It’s possible to experience depression after a prostate cancer diagnosis. The mental challenges of receiving a cancer diagnosis, combined with treatment side effects, may be difficult to manage.

While depression may happen after any cancer treatment, it may be worsened in men receiving androgen deprivation therapy (ADT).

Talk to your care team about managing depression, including psychological support and medications.

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