Complications Arising from Prostate Cancer or Its Treatment

Two types of complications may arise in relationship to prostate cancer:

  1. Those resulting from the disease itself
  2. 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

  1. Blockage of the bladder by urethral obstruction
  2. Bleeding in the urine
  3. Blockage of the tubes draining the kidneys into the bladder (ureters)
  4. Pelvic pain
  5. Bony pain
  6. Tiredness
  7. 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:

  1. Impotence (loss of erections)
  2. Incontinence (loss of urine) - Infomation on Kegel's exercises (pelvic floor muscle exercises)
  3. Obstruction (blockage of the urinary passage)
  4. Disease recurrence

 

Treatment-related Complications: Radiation

There are 5 general types of long-term complications which can arise following surgery:

  1. Impotence (loss of erections)
  2. Incontinence (loss of urine)
  3. Obstruction (blockage of the urinary passage)
  4. Bowel problems (e.g. diarrhea or loss of stool)
  5. 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 aleviate 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:

  1. Osteoporosis
  2. Loss of libido and erectile dysfunction
  3. Loss of muscle mass and weakness
  4. Hot flashes/night sweats
  5. Diabetes
  6. Cardiovascular disease
  7. Difficulty with memory or concentration
  8. 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.

 

  1. 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.
  2. Make sure you get enough vitamin D - about 800 IU per day

 

Osteoporosis Information On The Web

The BC Cancer Agency patient information brochure for reducing the risk of osteoporosis can be found here.

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

 

  1. Primrose oil
  2. Advil or ibuprofen
  3. Effexor XR daily (37.5, 75 or 150 mg)
  4. Cyproterone acetate 50 mg daily

 

On the Web

General Prostate Cancer Web-Resources

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

UNDERSTANDING CANCER - Metrovan Urology info on the principles of diagnosis, staging, prognosis and more.

American Cancer Society

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.