Prostate Cancer Survivorship

Coping and your emotions

Patients and their families will experience a wide range of emotions, from relief and hopefulness to anxiety and fear. You’ll be adjusting to a “new normal” and may have concerns about cancer returning. Hormone therapy can also affect emotions. Depending on your treatment, you will have short- or long-term side effects that can impact many areas of your life. Here are suggestions for coping:

• Support groups are available. LVHN Men Facing Cancer meets in person or on a Webex. If you are interested in joining the group, call 610-402-6481 or email oncologysupportgroups@lvhn.org.
• Connect with family, friends or other men who have or had prostate cancer in person or find online communities.
• Oncology counseling is available at LVHN. Ask your care team for additional information.

Diet: Avoid sugar, tobacco and alcohol

After treatment, following a healthy diet and maintaining a healthy weight are essential to overall good health. Focus on a primarily plant-based diet that includes plenty of fruits and vegetables. Choose high fiber, low-fat foods and limit simple sugars. Stay adequately hydrated and limit alcohol consumption. Avoid all tobacco products.

Any patient that is treated for cancer at LVHN has access to a dietitian from Cancer Support Services. If you received treatment outside our network, you can be connected to resources within the network to help with your needs.

Exercise: Aim for 150 minutes a week

Exercise is part of a healthy lifestyle for everyone. Exercise as much as you are physically able, according to your personal fitness needs. A good standard is 30 minutes of physical activity five days per week, or more based on your personal fitness. If you’re new to exercise, in treatment or have advanced prostate cancer, consult your health care team to get an exercise program tailored for you.

Beyond aerobic exercise, strength training can be especially helpful in men on androgen deprivation therapy for advanced prostate cancer, who are at higher risk for loss of muscle mass, osteoporosis and also of weight gain, metabolic syndrome and diabetes.

Sex after prostate cancer

There’s usually no reason to avoid sex after prostate cancer treatment. Nearly all patients experience some level of erectile dysfunction for the first few months following treatment. About half of men will return to pretreatment function within a year, if the nerves responsible for erections are still intact.

Discuss medications or treatment options with your clinician and ask for assistance if you would like to seek counseling.

Managing side effects after treatment

All prostate cancer treatments have side effects. Some common side effects, which may cause long-term concern for patients, include the following:

Urinary dysfunction

Urinary dysfunction is a common side effect of prostate cancer surgery. Mild bladder leakage occurs in about 20 percent of men who have undergone a prostatectomy (surgical removal of the prostate).

Patients treated with radiation therapy are unlikely to experience leakage. However, they may be more likely to experience irritation that causes frequent urination or urgency, nocturia (excessive nighttime urination) or a sense of urinary urgency. Irritative urinary symptoms caused by radiation are often treated with drugs for a few weeks until symptoms improve.

For severe urinary dysfunction that isn’t improving, your doctor may recommend a surgical procedure. However, many side effects are short term and will resolve after treatment is complete. Other suggestions for management include:

• For leaks or loss of bladder control, use an incontinence pad and wear dark pants.
• Practice Kegel exercises. Opens in new tab Pelvic Floor Muscle (Kegel) Exercises for Males | Memorial Sloan Kettering Cancer Center
• Consult with LVHN’s urology team for evaluation and treatment of urologic problems.
• The Pelvic Floor Rehab Program is available to men to assist with urinary incontinence.

Bowel dysfunction

Though less common, bowel issues such as rectal bleeding or diarrhea can be side effects of radiation for prostate cancer due to the proximity of the prostate to the rectum. Dietary changes (e.g., increasing fiber intake or antidiarrheal medication) can treat symptoms. Men can also follow up with their clinician for suggestions. Severe bleeding, which is rare, may require electrosurgical treatment.

Erectile dysfunction

Nearly all patients will experience some level of erectile dysfunction for the first few months following treatment. About half of men will return to pretreatment function within a year, if the nerves responsible for erections are still intact.

Surgery and hormone therapy impact erectile function more so than radiation therapy. Radiation may increase the likelihood of dysfunction over time. Loss of libido caused by hormone therapy usually resolves after therapy is complete. Your urologist can discuss your options, including oral medications for erectile dysfunction, mechanical vacuum devices and surgical treatments.

Infertility

Many treatments including surgery and radiation therapy can cause infertility in men, making it improbable to have children after treatment. If you are hoping to have children, discuss your desire with your care team before treatment. Sperm banking may be your best option. A fertility specialist can also provide advice.

Importance of follow-up

Screening for prostate cancer recurrence is an important part of survivorship. Additionally, some cancer treatments may increase your risk for developing a secondary cancer. It’s important to follow up with your treatment teams as recommended and to report any new symptoms immediately to your clinician.

Active surveillance

Patients with slow-growing prostate cancer may choose active surveillance, delaying treatment until symptoms or test results indicate progressive disease. Follow the protocol including lab work, imaging and biopsy as directed by your clinician.