Prostate Cancer Treatment Side Effects | An Expert Overview

Katherine Banwell:

Could you go over the typical side effects of the treatment options?

Dr. Daniel Sentana:

Yeah. Well, this could be a talk on itself. But I would say, again, thinking about patients with localized disease, we’ve known for some time that the two big side effects that come with a surgical procedure or a removal of the prostate are problems holding urine, so urinary incontinence, and then there can be also issues with erections. And naturally, these are two very distressing, life-altering side effects.

So, it’s important for patients contemplating surgery to consider, how is my urine control and my sexual function going to be impacted? Not to say that these are going to be lifelong changes, but there is the possibility of that. And I and many of my colleagues are honest, and I think patients deserve to know that these are potential side effects that live with them for definitely a long time, if not forever.

For patients that choose radiation as a modality, it also comes with side effects. If there’s a message in here, it’s that everything has side effects. Unfortunately, it’s the cost of curing cancer. The side effects of radiation have to do more so with irritating things around the prostate, and that has to do with the bladder, which is on top, and the bowel, which is behind. So, people experience frequency of both of those sides. So, they feel like they have to urinate frequently, it might even burn if you have a urine infection when you urinate. And then, on the bowel end, there can be changes in the bowel habits, usually on the looser side.

And so, these are also side effects that obviously can make someone’s day-to-day very different, and you have to time your bathroom visits, and all that. So, certainly many, many things to consider there.

For most of the medications or systemic treatments that we have, I would say the hormonal ones, I tell patients it’s a little bit like going through menopause, which men –

Katherine Banwell:

For a man, that might not be easy to understand.

Dr. Daniel Sentana:

Exactly. Men don’t experience menopause generally. Many times, their partners next to them in the room are like, “Well, now you’re going to live through this.” But certainly, it’s a number of side effects such as fatigue, changes in your body shape and weight, there can be hot flashes, your mood can also be very variable. And the longer you have low testosterone with these therapies, then we have to worry about things like your bone and muscle strength as well as your heart because there is an increased risk of cardiovascular disease with medications that affect testosterone.

For our more advanced patients that are going to get things like chemotherapy or radioactive compounds, there’s a whole host of other side effects that can happen. But broadly speaking, those cause low blood counts for the most part, they can cause fatigue. A lot of my patients are worried about hair loss, but actually most of the cancer treatments we have in prostate don’t necessarily cause hair loss.

But all this to say is that it’s the tradeoff is different when you are looking at a curative treatment, as surgery or radiation, versus something that is a treatment to control the cancer for a long time. And so, the willingness of someone to go through the side effects is different. If you said, “We can do this. It might lead to incontinence issues, but hopefully the cancer will be gone forever”, it’s a different situation that, “You have to stay on this treatment for so long and it can cause a list of side effects.”

Everyone is different, but I think it’s important going back to our earlier conversation about, “Where am I in this disease spectrum and what is valuable to me?” Because that is very important for us to know as a provider is, what does a patient value and how are the symptoms they’re already having and their worries or concerns going to play into treatment selection?

Katherine Banwell:

Well, that leads me to my next question. Why is it so important that patients communicate with their healthcare team about any side effects they’re experiencing?

Dr. Daniel Sentana:

For many reasons, but certainly for at the end of the day, they are the ones going through this. We have the experience of treating many patients with prostate cancer throughout the years, but ultimately every person’s experience is their own. And so, it’s important for us to understand, how is this treatment affecting you? And many times we’ll be able to say, “Oh, yes, that’s a very common side effect, and here’s something that we know works to help you with it.” Other times it might not be so obvious, and it could be from a completely separate issue, or it could be a new thing that only over time we’ll realize is a complication from our treatments.

And even before you go on cancer treatment, many of our patients already have symptoms from their prostate cancer, whether that’s changes in urination or straining that they have to do. Other times, if they have advanced prostate cancer, they might have pain somewhere where the cancer is or they might have fatigue.

So, really helping us understand how is not only the cancer affecting your health right now, but what worries you about going on these therapies is very important because this is a partnership. We’re here to get you through this disease. And if we cannot get rid of it, then at least keep it under good control for a long time. And so, we need to find what works for you. It’s not about our priorities, it’s about what is meaningful and what makes sense for you as a patient.