Side Effects

Prostate cancer treatment side effects

Prostate cancer treatments come with the risk of side effects. Side effects are unwanted and unpleasant symptoms or reactions caused by treatment not by the prostate cancer itself. They happen because many of the treatments can affect other parts of the body, as well as the prostate gland.

Side effects of prostate cancer treatments may be temporary, longer term or permanent. Many side effects can be easily managed but some are more serious and require medical treatment.

Managing side effects during and after treatment can be challenging and stressful. It’s important to find out as much information as you can about your prostate cancer treatment and its side effects so you can be better prepared and understand how your doctor and healthcare team can support you.

Prostate cancer treatments can affect men differently. You may experience minimal or no side effects while other men may be troubled by various symptoms. If you have any questions about these treatments or their associated side effects talk to your doctor, healthcare team or call a PCFA nurse on 1800 22 00 99.

Some problems that may require urgent medical attention include:

a urinary tract infection (symptoms include fever, pain, stinging while urinating, pain in your kidney area, feeling unwell, smelly or cloudy urine)
blood in your urine or semen
not being able to urinate
bleeding from your rectum (bottom)

Contact your doctor, a member of your healthcare team or go to the emergency department if you experience any of these problems

Never ignore blood in your urine or semen – see your doctor immediately

This section of your toolkit aims to give you an overview of the side effects associated with each treatment, including:

Active surveillance side effects
Hormone therapy side effects
Surgery side effects
Radiation therapy side effects
Chemotherapy side effects
Focal therapy side effects
Theranostics side effects

For all treatments follow the links below to learn more about side effects related to:

Fatigue
Bladder Function
Bowel Function
Bone Health
Sexual Function
Mental Health

Active surveillance side effects

Active surveillance does not involve active treatment. It involves actively participating in a structured regime that monitors your prostate cancer through regular PSA tests, digital rectal examinations, biopsies and/or imaging tests to check if your cancer is changing. If you have a biopsy as part of your active surveillance protocol, you may have pain, bruising and blood in your urine and semen after this procedure. These side effects generally only last a short time, are manageable and don’t affect your bladder, bowel or sexual function.

Some men also experience increased psychological distress while being treated with active surveillance. If you do, it is important to talk through your concerns and worries with your health care team and seek additional support.

Learn what to look out for after a biopsy, find out about active surveillance and where to get support if you feel distressed.

Hormone therapy side effects

The type and likelihood of having side effects from hormone therapy depends on the type of medication you’re taking and the length of time you’re on it. Learn more by following the link to Hormone Therapy.

Side effects occur while you’re taking hormone therapy medications but may diminish over time or if you stop treatment. However, it can take 3 to 6 months and sometimes longer for your side effects to wear off. You may also continue to have side effects.

Recovery from hormone therapy side effects can depend on:

Your age
The type of hormone therapy you take
Whether you take hormone therapy for a few months, several years or the rest of your life
If you take hormone therapy continuously or in cycles of stopping and restarting, this is called intermittent hormone therapy

What side effects might you experience on hormone therapy?

Fatigue (tiredness) – this is the most common side effect
Nausea
Hot flushes and night sweats – these are common and can start as soon as you begin treatment
Changes in your sexual function and fertility
Declines in your bone health and muscle strength
Memory, concentration and emotional changes and effects on your mental health
Weight gain and increased body fat – especially around your abdomen
Breast enlargement and tenderness
Possible increased risk of heart disease and diabetes – make sure you have regular health checks with your doctor and read the Health & Wellbeing section of your toolkit to find out how you can stay healthy and reduce your risk
Headaches
Skin symptoms – dry skin, itchy skin or rashes

Follow the links below to learn more about how hormone therapy can affect:

Sexual Function
Bone Health
Bowel Function
Fatigue
Mental Health

What are hot flushes and night sweats?

Hot flushes are a sudden feeling of warmth in your face your upper body and/or through your whole body. When these occur at night, these flushes are often called night sweats. They can last from a few seconds of feeling overheated to a few hours of sweating.

Hot flushes happen without warning and can be:

Mild – lasting for less than a few minutes when you may feel warmer and a little uncomfortable
Moderate – you feel hot and sweaty and want to remove some of your clothes
Severe – you feel very hot and sweaty to the point that you may need to change your clothing or bedding and/or you may feel irritable, nauseous (feeling sick) and great discomfort

You may also feel cold, shivery or washed out after having a hot flush.

Over time you may find that the flushes become milder and occur less often, but they can sometimes continue throughout treatment or longer. Mild hot flushes may not need to be treated, but if they’re affecting your sleep and quality of life talk to your doctor or a member of your healthcare team.

How can you manage hot flushes and night sweats?

It may be useful to keep a diary of your symptoms. This can help work out if anything triggers your hot flushes. The trigger can then be avoided or your healthcare team may offer you medication to help reduce your symptoms.

Ways that you can manage hot flushes include:

Drink at least 6 to 8 glasses of water per day
Reduce alcohol intake and drinks that contain caffeine such as tea, coffee and cola
Reduce the amount of spicy food you eat
Keep your room at a cool temperature or use a fan
Use light cotton bed linen
Lay a towel on top of your sheet – this can be easily changed if you sweat during the night
Wear cotton clothes, including underwear, especially at night – cotton ‘breathes’, unlike synthetic materials that can make it difficult for the air to circulate in and around your body
Take lukewarm showers or baths rather than hot ones
Consider acupuncture – some research indicates that it may give you some relief

How does hormone therapy affect bones, muscles and body weight?

Your body shape and physical strength may change while you’re on hormone therapy. Hormone therapy reduces your testosterone levels, which can cause you to lose bone density and muscle strength and to gain body fat. Loss of bone density makes bones brittle and increases your risk of fractures.

Weight gain is often reported in the first 12 months after starting hormone therapy and is particularly noticeable around the waist (belly fat). Losing weight can be difficult and it can be disturbing to put on weight, especially if you’ve never had a problem with your weight before. Also, evidence shows that anyone who is overweight has a greater risk of developing other illnesses such as heart disease and diabetes.

The Health & Wellbeing section of your toolkit provides information on how to improve your diet, lifestyle and physical activity, which may help you manage your weight and improve your muscle and bone strength. Make sure you talk to your healthcare team before making any major lifestyle changes.

How does hormone therapy affect breast tissue?

Swollen, enlarged and tender breasts in men is called gynaecomastia. This occurs because of the effects of hormone therapy on your testosterone levels.

This side effect isn’t usually an obvious or significant problem but can affect one or both breasts and can vary from mild swelling to much more noticeably enlarged breasts. It can also cause symptoms from a very mild sensitivity to ongoing pain. Talk to your doctor about treatment if this side effect is bothering you.

Surgery side effects

What are the possible lymph gland side effects of prostate cancer surgery?

There are always risks and possible complications with surgery to remove your prostate (also called radical prostatectomy). You may also suffer from side effects that can be short-lived, long-term or permanent.

These possible side effects include:

Effects on urinary/bladder function
Changes in sexual function
Bowel function changes
Fatigue (often short-term after surgery)
Lymph gland side effects

Follow the links below to learn more about how prostate cancer surgery can affect:

Bladder Function
Sexual Function
Bowel Function
Fatigue

If you had lymph nodes (glands) removed during prostate cancer surgery, you may experience:

A cyst containing lymphatic fluid (also called a lymphocele) in the area where your lymph nodes were removed
- This is a benign (not cancer) cyst and may get better on its own or you may need to see your doctor to have it drained
Minor swelling in your legs (lymphoedema) from lymph nodes not draining properly and causing a build-up of fluid
- This symptom is very rare, but it may help for you to see a physiotherapist to manage the swelling if it occurs

Follow the link to Pre- & Rehabilitation to learn more about dealing with lymphoedema and talk to your doctor or healthcare team about any concerning symptoms you have after surgery so they can give you the necessary treatment and support.

Radiation therapy side effects

Radiation therapy can cause side effects early during your treatment sessions (usually 1 to 2 weeks into treatment if you are having external beam radiation therapy) and later after you’ve finished treatment (for months to years). Early side effects usually improve within 1 to 2 months of finishing treatment. Late side effects are less common than early side effects.

If you experience any urinary and bowel side effects, they are usually caused by your radiation therapy irritating the lower part of your bladder, your urethra, and the front part of your rectum (lower bowel).

Side effects of radiation therapy can include:

Fatigue (tiredness) – this is very common during radiation therapy
Issues with urination and bladder function
Changes and problems with bowel function
Effects on your sexual function
An increased, but small, risk of getting a second cancer due to having radiation treatment

Follow the links below to learn more about how radiation therapy can affect:

Fatigue
Bladder Function
Bowel Function
Sexual Function

You need urgent medical help if you’re unable to pass urine following your radiation therapy. Contact your healthcare team and/or go to your closest hospital emergency department.

Chemotherapy side effects

How can you manage some of the side effects of chemotherapy?

Chemotherapy is a treatment for advanced cancer that has metastasised (spread) to other parts of your body.

Chemotherapy works by targeting cells in your body that are rapidly dividing into two cells. This is how new cells are normally made in your body, but cancer cells usually divide more often and/or faster than healthy cells. So, cancer cells are more likely to be killed by chemotherapy. However, healthy cells in certain parts of your body, such as bone marrow, hair follicles and your gut, naturally divide rapidly and can also be affected by chemotherapy.

Chemotherapy can cause various side effects, such as:

Loss of appetite, nausea and/or vomiting
Fatigue (tiredness)
Bowel function, including constipation or diarrhoea
Infections, bruising and anaemia – damage to your bone marrow by chemotherapy can reduce your blood cell counts
Hair loss – hair usually grows back after treatment stops
Skin changes – dry, itchy or sore skin
Nail changes – brittle or cracked nails
Sore mouth and throat
Lymphoedema – fluid build-up and swelling of your lower limbs
Watery eyes and runny nose
Numbness or tingling in your fingers or toes
Infertility

Follow the links below for more information on the side effects and their management for:

Fatigue
Bowel Function
Bone Health
Sexual Function

Many of the side effects caused by chemotherapy improve on their own, but they can be challenging. The following tips can help you to manage some of the symptoms. If you have any concerns or symptoms that you can’t manage, talk to your specialist or healthcare team so they can support you. You can also call a PCFA nurse for advice.

How do you manage appetite changes, nausea and vomiting?

Eat small meals and snack when you’re hungry – small amounts of food and fluid taken frequently can help with nausea
Concentrate on having nutritious snacks when you can eat, such as dried fruits and nuts, yoghurt, cheese, eggs and milkshakes
Drink fluids between meals rather than with meals
Avoid strong smells and eat food that is cold or at room temperature, if the smell of food makes you nauseous
Talk to a dietitian about a diet plan that can improve your appetite, suggest food that is easy to eat, and help you keep up your fluid and food intake, even if feeling nauseous

What can soothe a sore mouth or throat?

Try different food and drinks to see what is easy to eat and drink
Avoid alcohol, tobacco or other things that can irritate the lining of your mouth

What can be done about hair loss and skin and nail changes?

Talk with members of your healthcare team about ways of keeping your hair, scalp and skin healthy
Use a hair piece if it would make you feel more comfortable – a member of your healthcare team or your local Cancer Council can advise and help you with getting a hair piece
Talk to your doctor about a referral to a psychologist if your physical appearance causes you discomfort
When washing your hands or body, use non-perfumed soap or soap replacement (e.g., sorbolene cream)
Use moisturising cream on your hands and body to stop skin dryness and cracked nails
Wear loose-fitting clothing so your skin is not aggravated further

Focal therapy side effects

Focal therapies are emerging and experimental treatments that aim to target your prostate cancer but also protect healthy surrounding tissue and reduce the risk or severity of side effects. This does not mean they never have side effects.

With focal therapies you may still experience some degree of:

Erection problems
Rectal (‘back passage’ or ‘bottom’) pain
Issues with urination

Follow the links for more information:

Sexual Function
Bowel Function
Bladder Function

Ongoing research will provide more information on the side effects of focal therapies.

Theranostics side effects

Theranostics, such as PSMA therapy (commonly using Lutetium-177), is a targeted therapy that ensures healthy parts of your body without cancer are not exposed to excessive doses of radiation therapy. This can reduce side effects. However, you may still experience:

Nausea or vomiting
Bowel function issues, such as constipation or diarrhoea
Anaemia and an increased risk of infection due to low blood cell counts this may lead to fatigue
Dry mouth
Dry eyes or blurred vision
Damage to sperm, which may affect fertility – follow the link to Sexual Function

Ongoing clinical trials will provide more information on the side effects of theranostics.

Key points

All prostate cancer treatments have potential side effects
Side effects vary with each treatment and affect all men differently
Side effects may last a short time or may have long-term or permanent effects
Many treatments cause fatigue (tiredness) but treatments can also affect various areas of the body, including:
- Sexual function
- Bowel function
- Bladder function
- Bone health
- Mental health
Side effects can also include eating problems, hot flushes, headaches, hair loss, skin and hair changes, swelling in your legs, and mouth and throat issues
Newer, emerging therapies, such as focal and theranostic therapies, aim to reduce treatment side effects but you may still have some symptoms
Most side effects can be treated, talk to your doctor or contact a PCFA nurse