Controlling symptoms of advanced prostate cancer
Advanced prostate cancer may cause unpleasant symptoms. These may be relieved by treating the cancer itself.
Sometimes treatments work quickly and you may notice an improvement within a few days. Other treatments may take longer to work, so it can be a couple of weeks before you begin to feel any benefit.
Apart from treating the cancer itself, there are many other ways to help relieve symptoms. This section talks about what options may be available to you.
There are many different types of painkillers. They vary both in their strength and in the way they work. Some painkillers are better for certain types of pain, and some suit certain men better than others. It’s often better to take painkillers regularly, even if you’re not in pain when the next dose is due. This is because painkillers not only relieve pain at the time, but prevent it from coming back too.
Painkillers can be taken as tablets, liquids, or as suppositories that are inserted into the back passage. Some are also given as injections under the skin or patches that are applied to the skin.
It’s important to tell your doctor or nurse if the painkillers you’re taking aren’t easing your pain. Your doctor can either change the dose or change the painkillers to something else that will be more effective for you.
Pain caused by prostate cancer cells in a bone can be severe. Radiotherapy is very good at easing this type of pain, but can take a few weeks to work. Often drugs containing morphine are needed while the treatment is being planned, or while you are waiting for the radiotherapy to work.
Some men find that morphine makes them feel drowsy when they first start taking it, but this usually only lasts for a day or so. Taking morphine may also make some men feel sick at first, and they may need to take an anti-sickness (anti-emetic) tablet prescribed by their doctor for the first few doses. It may also cause constipation.
A number of other drugs can help to relieve pain. If pain is due to prostate cancer cells in a bone, non-steroidal anti-inflammatory drugs (NSAIDs) can help. These have few side effects, but can sometimes irritate the lining of the stomach.
Drugs called bisphosphonates can also help relieve bone pain. Bisphosphonates such as Zoledronic Acid (Zometa®) can help to strengthen bones and lower the risk of fractures. They can also reduce high levels of calcium in the blood (hypercalcaemia), as well as reduce pain. They may be given into a vein (intravenously) in the outpatients department every 3-4 weeks.
Denosumab is a new drug that helps to protect the bones, but it works in a different way to bisphosphonates. It may not be widely available - your doctor can give you more information.
If you’re having trouble sleeping because of pain, your doctor can prescribe sleeping tablets or a mild relaxant.
Anxiety and lack of sleep can make pain worse. For this reason, some men also find that practising relaxation techniques helps them feel more comfortable. A gentle massage can also help your body relax and distract your mind from pain. It’s advisable to have a massage from a trained massage therapist who works with cancer patients.
Heat can also help to ease pain. A long soak in a warm bath, a heat pack or a well-protected hot water bottle can all bring some short-term pain relief for some men.
Being in pain can make you feel very low. It’s important to let your doctor know if the drugs prescribed aren’t working. Remember there are many different ways to control pain. There are special NHS pain clinics run by doctors and nurses who are experts in treating pain. You can ask your doctor to refer you to a clinic if your pain is not controlled by any of the methods mentioned here.
We have more information in our section on controlling cancer pain, and our section on called the symptoms of cancer, which you may find helpful.
Malignant spinal cord compression
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If the bones in the spine are affected by the cancer, it can sometimes lead to weakness and tingling or numbness in the legs due to pressure on the spinal nerves. This is called malignant spinal cord compression. Some men may have pain that comes on quickly and is different from their normal pain. They may also have problems passing urine or controlling their bowels. Constipation may also become a problem.
Treatment can often prevent permanent damage to the nerves. It’s important to contact your cancer specialist immediately if you develop any of the symptoms mentioned here. We have more information about malignant spinal cord compression.
You may find that you easily become tired and that your body is no longer as strong and reliable as it once was, either because of the cancer or the side effects of treatment. You may feel that you have no strength and everything is more of an effort.
It can be difficult to adjust if tiredness makes it difficult for you to drive or take part in your usual activities, or if you have to walk more slowly than before. It’ll take time to get used to these changes. You may need to rest more, and you may be unable to do the things you once took for granted.
If you have little energy, save it for the things you really want to do. Very often, re-organising your daily activities can be helpful – for example, by setting aside a time to rest every day. Practical aids such as wheelchairs can also be useful. You may feel that by using a walking stick, frame or wheelchair you are ‘giving in’ to your illness, but they can greatly improve your life, allowing you to move around more easily.
You may find our section on coping with fatigue helpful.
Sometimes the cancer or the treatment can cause anaemia, which can make you feel tired. If this happens, you may be given a blood transfusion, which can often give you more energy and reduce tiredness.
Constipation can be caused by taking strong painkillers or if you have too much calcium in your blood. It can also occur if you lose your appetite and are not eating as much as before, or if you are getting less exercise.
Having fibre in your diet, drinking plenty of fluids and walking will help, but you may also need to take a medicine (laxative) to stimulate the bowel. Your doctor will be able to prescribe one that’s suitable for you. Your nurses can also advise you on ways to prevent or relieve constipation.
Difficulty sleeping (insomnia)
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Even though you may feel tired, it’s not uncommon to have difficulty sleeping. You may have a lot on your mind, and this can add to the problem.
Sleeping tablets can be helpful, and the newer types now available are less likely to make you feel drowsy the following day. You can also try some natural remedies like drinking malted milk or chamomile tea before bed, a glass of brandy or whisky in the evening, having a warm bath with soothing bath oils, or a relaxing body massage to relieve muscle tension. We have more information that could help if you have difficulty sleeping.
High levels of calcium in the blood (hypercalcaemia)
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Prostate cancer cells in a bone may make extra calcium pass out of the damaged bone and into the blood. High levels of calcium in the blood can make you feel extremely tired and thirsty, and you may pass lots of urine. Hypercalcaemia can also make you feel sick, and some people become irritable and confused.
Depending on your calcium level, you may be able to have treatment as an outpatient or you may need to spend a few days in hospital.
Your doctor will give you drugs called bisphosphonates. These drugs are given as a drip into a vein in your arm. Each treatment takes between 15 minutes and one hour, and can be repeated every few weeks. They are usually effective at getting the calcium levels back to normal. Your doctor may also ask you to drink plenty of water. Sometimes the drip will be used to give extra fluids into a vein in your arm (an intravenous infusion).
You may need an operation if prostate cancer cells have weakened a bone so much that there’s a risk of it breaking. This is done under a general anaesthetic.
The surgeon will put a metal pin into the centre of the bone and may also fix a metal plate to it. This holds the bone firmly so it won’t break. The pin and plate can stay in permanently. This is mainly used for the long bones in the legs, but is sometimes used when there are secondary cancers in other bones such as the spine. If your hip is affected, the hip joint may be replaced.
You’ll need to stay in hospital for a week or longer after the operation so you can fully recover. However, most men are able to get up and start walking around a couple of days after surgery.
This sort of operation may be done before radiotherapy is given, if there is a chance the bone may break before the radiotherapy has treated the cancer cells.
If your doctors feel the bone is unlikely to fracture, bisphosphonates may be used to help strengthen the bone and prevent it from breaking.
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Some men find that complementary therapies can help them feel stronger and more confident in dealing with advanced prostate cancer. It’s important to tell your doctors if you’re planning on using any complementary therapies. They can usually be used alongside conventional treatments and medicines.
Complementary therapies can help to improve quality of life, and can sometimes help to reduce symptoms. Some complementary therapies, such as meditation or visualisation, can be done by the person with cancer themselves and can help reduce anxiety. Other therapies such as gentle massage can be carried out by a trained massage therapist, and relatives and carers can be shown how to do it for you at home.
Gentle physical contact and touch can be among the most powerful forms of support for people who are faced with uncertainty, fear or pain, whether emotional or physical.
Many hospices and hospitals offer complementary therapies alongside conventional care. These may include:
colour and sound therapy
relaxation, visualisation or guided-imagery techniques