Prostate Cancer Treatment Side Effects: What Men Need to Know
Selecting a prostate cancer treatment can be a difficult process for men and their doctors. While this form of cancer is often highly treatable, each intervention comes with its own potential side effects. These effects may vary greatly from patient to patient, ranging from none to those that may create concerns that last a lifetime.
Understanding the potential side effects each treatment option may pose can help men and their doctors choose the most suitable intervention. The possible side effects will vary based on the procedure recommended.
This is a surgical procedure that removes the diseased prostate entirely from the body. To understand the primary side effects that may accompany this surgery, it is helpful to understand the location of the prostate within the body. This gland is found behind the pelvic bone, in front of the rectum. It is located just below the bladder with the urinary sphincter control muscle just below it. Erectile nerves are found just outside the prostate, flanking it on both sides. Inasmuch, the main side effects associated with the radical prostatectomy are erectile dysfunction and incontinence. Patient age and health may play roles in determining the risks surgery may pose.
A radical prostatectomy is considered a major surgical procedure. Inasmuch, it also presents the possibility for side effects associated with any major operations. These risks include infections, blood clots, injuries to nearby tissue and the possibility of pulmonary or cardiac events.
The Radical Retropubic Prostatectomy (RRP) and the Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) both have similar short- and long-term side effects associated with them as follows:
- Short-term side effects – Immediately after surgery, all men will face urinary leakage. In most cases, a fair amount of bladder control is regained within about 12 weeks and will likely continue to improve over the next 12 months. Many studies have shown it may take several months for a patient to recover normal erections even when bilateral nerve-sparing surgery is performed. RALP is known to offer the advantage of reduced risk for bleeding. It is also associated with a shorter hospital stay.
- Long-term side effects – Studies have shown that less than 5 percent of patients will face severe incontinence that persists. Mild incontinence associated with laughing, sneezing or coughing may occur in up to an additional 5 percent of patients. About 90 percent of patients who undergo the RALP procedure demonstrate strong urinary control and require no leak protection after a 12-month period. Men with “normal” pre-operative sexual function are 72 percent likely to have adequate erections following a bilateral nerve-sparing procedure. About a quarter of patients require PDE-5 inhibitors to reach optimum potency levels. If a unilateral nerve-sparing procedure is performed, about 38 percent of men will have erections that are considered adequate for sexual activity. Less than 1 out of 10 men who undergo non-nerve-sparing procedures have erections that are considered adequate for intercourse following surgery. For patients who face persistent erectile dysfunction after surgery, procedures such as penile implants may restore normal sexual function.
Radiation treatment is often recommended when prostate cancer is diagnosed. This treatment option may be used on its own or in conjunction with a radical prostatectomy. Radiation is meant to eradicate prostate cancer by irradiating diseased cells. Although highly effective in many cases, this form of treatment does not spare nearby healthy cells. Inasmuch, organs near the prostate may suffer damage during treatment.
As it is with a radical prostatectomy, radiation may present with short- and long-term side effect risks. They are as follows:
External Beam Radiation
- Short-term side effects – Early side effects of this treatment generally center on irritation to the bladder and rectum. Men may experience frequency and urgency with urination, for example. It is also not uncommon for men to notice weaker urinary streams, the need to get up more frequently at night to urinate and looser, irregular bowel movements. These side effects tend to appear about half-way through a course of treatment and may increase gradually in intensity until treatment ends. They do typically resolve within a few weeks after treatments have been completed.
- Long-term side effects – Men will find that late effects are much less common than those that appear during treatment. They can, however, be longer lasting and more serious if they do appear. Incontinence and urinary stricture are rare, but may occur. This is more common in patients who demonstrated significant urinary problems before treatment began. Erectile dysfunction may also occur and is often linked directly to a patient’s age and erectile function prior to treatment. Erectile dysfunction symptoms may be eased with the use of PDE-5. Rectal inflammation is also a possibility, but only rarely becomes serious enough to demand treatment.
Prostate Seed Implants (Brachytherapy) or High Dose Rate Radiation
- Short-term side effects – Perineal discomfort and some bruising may appear immediately after the procedure. It is also common for increased urinary frequency, urgency and weak streams to present. Nighttime urination may also be a concern shortly after treatment. These side effects typically appear for four to six weeks after treatment, but begin to subside over the course of three to six months.
- Late-term side effects – Side effects that appear following treatment are rare, but not unheard of. As it is with external beam radiation, these effects may last longer and be more serious should they arise. Incontinence and urinary stricture are not common, but may appear in patients who displayed significant urinary concerns prior to treatment. Erectile dysfunction may also appear. It tends to be associated to prior function and patient age. Rectal inflammation may also be a concern, but very rarely is serious enough to require medical intervention.
Other treatments may include cryotherapy, HIFU, chemotherapy and Hormone Therapy (or ADT). The side effects associated with each differ and are as follows:
- Cryotherapy – Less data is available on the long-term side effects of this treatment and its effectiveness than is available for surgery or radiation. This treatment is generally pursued when patients are not good candidates for either radiation or surgery.
- HIFU – High Intensity Focus Ultrasound may produce such side effects as urinary frequency, rectal wall injury, impotence, incontinence and urinary burning.
- Chemotherapy – This course of treatment may result in such side effects as increased risk of infection, anemia, easy bruising, hair loss, vomiting, diarrhea, mouth sores and nausea.
- Hormone therapy – Also known as androgen deprivation therapy, or ADT, this form of treatment may cause reduction in libido, hot flashes, weight gain, breast enlargement, muscle loss, fatigue, osteoporosis, anemia and impotence.