7 Symptoms of Advanced Prostate Cancer and How to Manage Them
Learn about the symptoms of advanced prostate cancer, and discover the best ways to manage them.
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In about 80 percent of cases, prostate cancer is detected when it’s confined to the prostate or the region around it. But in advanced prostate cancer, also known as stage 4, the cancer has spread to other parts of the body, outside of the prostate gland. As a result, men with advanced prostate cancer may experience a range of symptoms, including bone pain, erectile dysfunction, and fatigue.
Talking to your doctor about any advanced prostate cancer symptoms you’re experiencing can help you brainstorm ways to address them. Your doctor may also refer you to a palliative care specialist, who can help you get the most out of life by helping you manage pain, anxiety, depression, and other issues related to cancer or treatment for the disease.
Although there is currently no cure for advanced or metastatic prostate cancer, there are ways to slow the spread, help you live longer, and control your symptoms.
Here are some of the most common symptoms of advanced prostate cancer, along with suggestions on how to manage them.
Advanced prostate cancer can cause these symptoms.Everyday Health
1. Pain
Pain in the back (spine), chest (ribs), hips, or other areas is common among men with advanced prostate cancer, particularly if the cancer has spread to the bones. Medications available to help control pain can be given orally, through a skin patch, or intravenously. Treatments such as radiation therapy and surgery are sometimes used to help relieve pain, too.
Some complementary approaches, such as acupuncture, biofeedback, healing touch, and yoga, may also help manage pain.
Consider seeing a pain specialist for help, as oncologists are specialists in cancer treatment but not necessarily in pain management. Many hospitals have pain-relief experts, who can tailor your treatment plan to your exact symptoms.
There are steps you can take to help manage the common symptoms of advanced prostate cancer, which include pain, fatigue, and loss of appetite.Getty Images
2. Fatigue
Cancer-related fatigue is much more than sleepiness or feeling drowsy. You may still feel tired after sleeping or taking a nap, and your lack of energy can keep you from normal activities. You may have trouble thinking, concentrating, or finding the right words.
Certain cancer treatments, such as chemotherapy and radiation, can cause fatigue. Anxiety, stress, and changes in your diet or sleep patterns can make it worse.
There are many steps you can take to manage fatigue:
Rest, but don’t stay in bed or sit in a chair more than necessary. Too much rest can actually zap your energy.
Try to add activity to your days. Although it may seem counterintuitive, moving more can give you energy. Just be sure to space out more demanding tasks, allowing for periods of rest in between them.
Keep a regular sleep schedule and don’t take long naps. Keep them to 40 minutes or less.
Stay hydrated by drinking at least eight 8-ounce glasses of water daily to fend off dizziness and feel stronger.
Ask a friend or family member for help with activities and chores that you find tiring or difficult to complete.
Do light exercise if it feels helpful and your oncologist approves it. Staying active can actually reduce fatigue and help you get better sleep.
Try activities such as meditation, yoga, and guided imagery to help reduce fatigue.
In some cases, your fatigue may be the result of anemia, which can occur as a side effect of chemotherapy. Other than fatigue, symptoms of anemia may include being very pale, dizziness, an elevated heart rate, headaches, low blood pressure, and shortness of breath.
Report any fatigue to your doctor to help get to the root cause and determine the right strategies to help you manage it.
3. Loss of Libido and Erectile Dysfunction
The hormones that are often used to treat advanced prostate cancer can decrease libido and cause erectile dysfunction (ED), which occurs when a man isn’t able to have or keep an erection. This can make maintaining an active sex life a challenge.
As a result, for couples, “There’s a real struggle to recover that sense of life together — how to be intimate without having sex,” says Michael J. Morris, MD, a genitourinary medical oncologist at Memorial Sloan Kettering Cancer Center in New York City.
Depending on the type of treatment that caused the ED, the ability to have an erection may improve over time. Treatments are also available to help with ED, ranging from medications to implants.
You and your partner can also explore other ways to be intimate in your relationship. A sex therapist or couples counselor may be able to help.
4. Nausea and Vomiting
Nausea and vomiting are common side effects of cancer treatment, especially chemotherapy.
Nausea can make it difficult for you to eat. If this is the case, try eating smaller meals five or six times a day and avoid foods that are fatty, spicy, strong smelling, or sweet.
If nausea is causing you to throw up, there are antinausea medications called antiemetics that may help. You should also drink as much liquid as you can to keep your body from becoming dehydrated as you lose fluids. Water, broth, and clear soft drinks are good choices.
5. Loss of Appetite
Many men with advanced prostate cancer lose interest in food, have little appetite, and become unable to eat. Fatigue, pain, and changes in your senses of taste and smell can all contribute to a lack of appetite.
The American Cancer Society offers the following tips to help you get the nutrition you need:
Eat what you want, when you want (for example, if you love breakfast and want it for dinner, go for it!).
Aim for several small meals throughout the day instead of just a few big meals.
Get more protein from high-protein smoothies, beans, cheese, eggs, and fish.
Add herbs such as chives, dill, or rosemary to give your food more flavor.
Gather friends and family to make mealtime more enjoyable.
A registered dietitian can advise you on dietary changes that can optimize your health. Your oncologist can also prescribe medications to alleviate nausea and boost appetite.
6. Cognitive Impairment
Some people with advanced prostate cancer experience cognitive impairment or confusion, caused by either the cancer itself or the medications used to treat it. And existing dementia can become more apparent after the diagnosis and treatment of prostate cancer.
Signs of confusion include reduced alertness, impaired thinking, and memory disruptions. You may forget where you are or what day it is.
If you experience this, you should notify your care team. Your doctor may decide to change your medication regimen. Brain “exercises”, such as Sudoku or crossword puzzles, may help keep you sharp.
7. Emotional Side Effects
In addition to physical symptoms and side effects, advanced prostate cancer can take a toll on your emotions.
A diagnosis of advanced prostate cancer can leave you feeling anxious, depressed, or overwhelmed. While this is common, you shouldn’t ignore the signs that anxiety or depression is getting worse, as there are treatments available that can help.
Signs of anxiety include an inability to stop worrying to the point where it can bring on physical symptoms such as tension and start to affect your daily life.
Feeling sad, irritable, or hopeless, losing your appetite or interest in your usual activities, and sleeping too little or too much are potential signs of depression.
If you’re feeling any of these emotions, be sure to talk to your doctor, who can prescribe medication for anxiety or depression and might also recommend seeing a therapist.
The Takeaway
Advanced prostate cancer can come with symptoms such as pain, fatigue, erectile dysfunction, loss of libido, nausea or vomiting, and reduced appetite. It can also have an impact on your emotional well-being.
If you’re experiencing advanced prostate cancer symptoms, it’s important to discuss them with your care team to come up with strategies to manage them.
Your care team may connect you with additional experts, including pain management specialists, palliative care specialists, couples counselors, dietitians, and therapists to help address your individual needs.
Walter Tsang, MD, is a board-certified medical oncologist, hematologist, and lifestyle medicine specialist. Inspired by the ancient Eastern philosophy of yang sheng ("nourishing life"), Dr. Tsang has developed a unique whole-person oncology approach that tailors cancer care and lifestyle recommendations to each patients’ biopsychosocial-spiritual circumstances. He partners with patients on their cancer journeys, emphasizing empowerment, prevention, holistic wellness, quality of life, supportive care, and realistic goals and expectations. This practice model improves clinical outcomes and reduces costs for both patients and the healthcare system.
Outside of his busy clinical practice, Tsang has taught various courses at UCLA Center for East West Medicine, Loma Linda University, and California University of Science and Medicine. He is passionate about health education and started an online seminar program to teach cancer survivors about nutrition, exercise, stress management, sleep health, and complementary healing methods. Over the years, he has given many presentations on integrative oncology and lifestyle medicine at community events. In addition, he was the founding co-chair of a lifestyle medicine cancer interest group, which promoted integrative medicine education and collaborations among oncology professionals.
Tsang is an active member of American Society of Clinical Oncology, Society for Integrative Oncology, and American College of Lifestyle Medicine. He currently practices at several locations in Southern California. His goal is to transform cancer care in the community, making it more integrative, person-centered, cost-effective and sustainable for the future.
Paul Raeburn is a journalist and blogger, and the author of five books, including, most recently, The Game Theorist’s Guide to Parenting, in 2016, and Do Fathers Matter?, in 2014, both published by Scientific American/FSG.
He is the author of more than 150 freelance articles for Discover, The Huffington Post, The New York Times Magazine, Scientific American, National Public Radio, and Psychology Today, among many others. He is a past president of the National Association of Science Writers. In addition, he was a media critic for the Knight Science Journalism Tracker from 2009 to 2012 and the chief media critic from 2012 to 2014.
Raeburn was the science editor and chief science correspondent at the Associated Press from 1981 to 1996, and a senior editor and writer at BusinessWeek for seven years after that. From 2008 to 2009, he was the creator, executive producer, and host of Innovations in Medicine and The Washington Health Report on XM satellite radio.
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