Complications Arising from Prostate Cancer or Its Treatment
Two types of complications may arise in relationship to prostate cancer:
Those resulting from the disease itself
Those resulting from treatment of the disesae
Every intervention in medicine is associated with potential complications (problems). The ultimate goal is to strive for the most benefit with the least (or no) complications resulting from treatment. Prostate cancer itself can cause many problems, including death, but not all tumors are destined to cause death. Some men may die with prostae cancer rather than as a result of prostate cancer. Therefore it is always important to weight the risk and benefits of each course of action.
Disease-related Complications
Prostate cancer can cause a number of complications from local and distant spread which include
Blockage of the bladder by urethral obstruction
Bleeding in the urine
Blockage of the tubes draining the kidneys into the bladder (ureters)
Pelvic pain
Tiredness
Death
Many of these complications are only seen with advanced prostate cancer. Men with localized disease without high risk features often enquire about urinary symptoms or aches and pains which they worry are caused by the cancer. It is exceptionally rare for men with localized disease to have symptoms as a result of prostate cancer. If you are concened that you are experiencing symptoms from prostate cancer, even if it is localized, please see your urologist.
Treatment-related Complications: Radical Prostatectomy
There are 4 general types of long-term complications which can arise following surgery:
Impotence (loss of erections)
Incontinence (loss of urine) - Information on Kegel's exercises (pelvic floor muscle exercises)
Obstruction (blockage of the urinary passage)
Disease recurrence
Treatment-related Complications: Radiation
There are 5 general types of long-term complications which can arise following surgery:
Impotence (loss of erections)
Incontinence (loss of urine)
Obstruction (blockage of the urinary passage)
Bowel problems (e.g. diarrhea or loss of stool)
Disease recurrence
Treatment-related Complications: Testosterone-Reducing Therapies
Broadly speaking, testosterone reducing therapies include surgical castration (removal of the testes) or medical castration (using drugs to either reduce or block the action of testosterone). Castration, medical or surgical, can put prostate cancer in remission and alleviate many of the symptoms men can experience from progressive cancer as well as enhance the curative effects of some treatments, such as radiation. However, the lack of testosterone can lead to a number of side effects which include:
Loss of libido and erectile dysfunction
Loss of muscle mass and weakness
Hot flashes/night sweats
Diabetes
Cardiovascular disease
Difficulty with memory or concentration
Weight gain
Fortunately, many men will tolerate hormonal therapy with minimal or few side effects and in most men, the benefits will far outweigh the risks. Prevention or treatment of some of these side effects is possible
Osteoporosis
Osteoporosis is a condition defined by thinning of the bones. Osteoporosis predisposes to fractures, especially of the spine and hip bones. While women are most at risk for this condition, many men develop osteoporosis as well. Hypogonadism, or low testosterone, is a major risk factor for the development of osteoporosis.
Lowering testosterone is a primary goal of hormonal treatment for prostate cancer. The most commonly used form of hormone treatment for prostate cancer uses LHRH agonists which decrease testosterone. While LHRH agonists can control prostate cancer, they can also increase the risk of osteoporosis.
There are a number of specialized tests which can be used to assess a patient's individual risk of having a fracture. A commonly used test in patients at risk are bone mineral density scans (BMD's). The FRAX score can integrate additional information to provide a more accurate assessment of fracture risk and is recommended by the World Health Organization. In some cases, the addition of a bisphosphate, a type of medication, can reduce the risk of a fracture further.
WHO Fracture Risk Assessment Tool
Regardless of whether your urologist orders a bone mineral density scan to check for osteoporosis (this is different than a bone scan to check for prostate cancer), all men should take steps to reduce their chances of developing osteoporosis. Fortunately, there are a number of easy lifestyle changes which can reduce your risk.
Obtain a satisfactory amount of daily calcium - about 1000 mg daily. Taking calcium above and beyound the recommended amounts can be harmful. Click here for the calcium content of foods.
Make sure you get enough vitamin D - about 800 IU per day
Osteoporosis Information On The Web
National Osteoporosis Foundation US-based website on osteoporosis
Osteoporosis.ca Canadian-based website on osteoporosis information
Hot Flashes
Hot flashes (sometimes also called hot flushes) are very common with androgen deprivation. These are very similar to postmenopausal hot flushes. The exact cause unknown. In most men they are not particularly bothersome but in some men profuse sweating and discomfort can occur. These typically resolve once testosterone levels return to normal. If treatment is necessary there are several options and these include:
Primrose oil
Advil or ibuprofen
Effexor XR daily (37.5, 75 or 150 mg)
Cyproterone acetate 50 mg daily
On the Web
General Prostate Cancer Web-Resources
Prostate Cancer Canada Resources
Prostate Cancer Basics: Screening and Diagnosis
Prostate Cancer Treatment Options
Prostate Cancer Post-Treatment Recovery and Side Effects
Memorial Sloan-Kettering Cancer Center in New York is an excellent resource for information on prostate cancer. Balanced, unbiased discussions of the disease, including discussion regarding some of the controversies in prostate cancer.
General Information on Cancer
BC Cancer Agency: Good general website from the British Columbia Cancer Agency. Has contact information on locations.
National Cancer Institute: Excellent source of understandable and mainly unbiased information. Several very good brochures on every stage of prostate cancer.
National Comprehensive Cancer Network: peer-reviewed expert content/prostate cancer guidance on evidence-based cancer diagnosis and management. Best for Prostate and Kidney Cancer. The most in-depth information is located in the physician section and requires registration.