How Will My Life Change During Prostate Cancer Treatment?

If you have recently been diagnosed with prostate cancer, you probably have many questions. The prospect of discussing treatment options with your doctor may feel overwhelming or stressful.

However, the more you know about your condition, the better prepared you will be to decide with your doctor what to do. In turn, your doctor can help you feel comfortable about what to expect during and after treatment.

The doctor should give the patient realistic expectations about all the different options. It is also very important for patients to be able to educate themselves.

Not everyone has the same priorities when it comes to treatment. Honest, open discussions with your doctor before deciding which treatments are right for you can therefore help you decide. The 5 questions we offer in this article may help you begin that conversation with your doctor.

How will my life change during treatment?

When considering treatment options for prostate cancer, you may want to know more about how your life will change during treatment. However, there is no simple answer, and it may vary greatly from person to person.

How much your daily life may change depends on several factors, including:

• Cancer stage: This refers to the size of the tumour and whether it has spread beyond the prostate gland. As cancer cells grow and spread, the cancer becomes harder to treat.
• Cancer grade: Tests help your doctor understand certain features of cancer cells, such as how quickly they grow. Higher-grade cancer tends to spread faster, while lower-grade cancer tends to grow more slowly. In a pathology report, the degree of cancer is described as its “grade”. For prostate cancer specifically, risk groups are also determined using the Gleason score.
• Treatment plan: Your doctor's treatment recommendation depends on factors such as your current health, age, and the stage and grade of the cancer. Some treatments may require time off to recover, while other options, such as active surveillance, may have very little impact on your life.
• Side effects: The most common side effects of prostate cancer treatments such as surgery and radiotherapy are urinary incontinence and sexual function problems. Hormonal treatments may also cause sexual function problems. Both may improve over time. Your doctor can help you manage side effects with strategies such as medication, medical devices and physical therapy.

Share your concerns and priorities with your doctor. We suggest asking some important questions to better understand how different treatments may affect your daily life and long-term outlook. You could consider asking:

• What are the possible complications (potential problems) of this treatment?
• How well is this treatment expected to control the disease?
• What effects does this treatment have on quality of life?
• What are the potential risks and outcomes of a more conservative approach?

Knowing which treatment options your care involves can also help you prepare. For example, you can get an idea of how much time you will need for appointments, hospital treatments and rest. You can also ask family and friends to help with tasks such as housework.

It is important to stay connected with loved ones during treatment. Even if you do not feel like socializing, family and friends can help preserve a sense of normality in your life.

What types of treatment are available?

There are various therapies for prostate cancer depending on the extent of the disease, your age, medical history and other factors.

There is no single approach to prostate cancer treatment that suits everyone.

The diversity of the disease is accompanied by a range of treatment options. For some patients, the priority is curing the disease, while for others it is quality of life.

The video below provides comprehensive information about prostate cancer diagnosis and treatment options.

The main types of prostate cancer treatment include

Active surveillance: Active surveillance may be a good option for someone with low-risk cancer. It may be recommended for people whose cancer grows slowly or who have other serious health problems.

This approach involves monitoring the cancer with regular tests and biopsies. Active surveillance is preferred when we do not consider the disease an immediate threat, but rather a process that needs monitoring over time.

Local ablative treatments: Local treatments, also known as “focal ablation”, focus on treating only the part of the prostate gland affected by cancer. They aim to preserve areas of the gland that remain healthy.

Focal therapy is not yet a standard treatment for managing prostate cancer. Researchers are critically examining the safety and effectiveness of focal therapy techniques to assess this innovative approach and identify appropriate candidates.

The disadvantage is that we do not have long-term cancer control data. Research teams are currently collecting these data.

The advantage is that side effects and complications are much less common than with some other types of treatment.

Radical prostatectomy: The most common operation for prostate cancer is radical prostatectomy. This removes the entire prostate gland. Radiation therapy is also recommended in some cases. Both radical prostatectomy and radiation therapy are curative interventions for early-stage prostate cancer. This means that a complete cure is possible if the cancer is confined to the prostate. The most common problems following these treatments are urinary incontinence and sexual function problems.

If you are considering surgery, we would like to emphasize that your surgeon's experience can make a difference. Technical complications are very rare for experienced surgeons. Typically, a patient comes in, has the prostate removed surgically and goes home within one or two days. In addition, half of our patients return to work within a few weeks.

Radiation / Radiotherapy: Radiation therapy is an option for most types of prostate cancer. It uses ionizing radiation or photons to kill cancer cells. When cancer has not spread outside the prostate gland, radiation therapy has approximately the same success rate as surgery.

Hormone therapy: Hormone therapy helps cancer cells shrink and grow more slowly by reducing levels of male hormones in the body. It is often used together with radiation therapy.

Hormone therapy can also be used when a person's cancer has spread too far for surgery or radiation to be effective.

For more advanced cases, different hormonal treatments and anticancer drugs may help. For example, chemotherapy and biological therapy are among the options for treating advanced prostate cancer.

What side effects should I expect during treatment, and how can I manage them?

The side effects you may notice depend on your treatment. It is important to ask your doctor which side effects to watch for.

Patients actually receive a great deal of information about possible side effects at diagnosis and the start of treatment. However, the shock at diagnosis and the fact that this is their first encounter with such information mean that it needs to be explained repeatedly.

If cancer is localized or locally advanced, some potential side effects of the most common treatments include:

Sexual function problems: Many people with prostate cancer experience changes in sexual function. This may occur after surgery, radiation therapy or other treatments.

Sexual side effects can be treated. It is important to speak to your doctor if you have symptoms such as:

• difficulty achieving or maintaining an erection
• difficulty reaching orgasm
• reduced sex drive or libido

Treatment for these symptoms may include medicines, physical devices that help erections, a surgical implant or a combination. Sexual function problems may also improve over time as your body recovers.

Urinary incontinence problems: People who undergo radical prostatectomy may experience urinary incontinence after surgery. In most cases, this resolves in less than a year. Pelvic floor strengthening exercises can be very helpful in regaining urinary control.

Radiation therapy does not usually cause urinary incontinence, but it can irritate the area. This may make you feel the need to urinate more frequently. This side effect usually resolves on its own after treatment ends. If it persists, please tell your doctor.

Bowel problems: Although uncommon, prostate cancer treatment can cause bowel problems such as diarrhoea, loose stools and rectal bleeding.

Loss of fertility: Anyone treated for prostate cancer with surgery, radiation therapy or hormone therapy may experience loss of fertility. During radical prostatectomy, the seminal vesicles and part of the vas deferens are removed. This disrupts the connection with the testicles.

Radiation also destroys the seminal vesicles (which produce the fluid in semen). Both hormone therapy and chemotherapy affect sperm production.

In most cases, fertility loss is irreversible. Before treatment, your doctor can tell you about options such as cryogenic (frozen) sperm storage. Freezing sperm may give you the chance to have biological children in the future.

Should I make any lifestyle changes during treatment?

In general, being physically active and eating a balanced diet is likely to have a positive effect on quality of life.

We recommend starting an exercise programme for people who were not previously very active. As for eating the right foods, our recommendations can be summarized as follows:

• eliminate processed foods from your life,
• significantly reduce red meat consumption,
• eat more fruit and vegetables.

There is no need for a major change. However, even small steps towards more exercise and healthier meals can help you feel more engaged with your health.

Where can I find support?

No one receiving prostate cancer treatment should feel that they have to face it alone. Resources are available locally and internationally to help patients during treatment and recovery.

Your doctor can recommend a wide range of support networks. These may include face-to-face support groups, online forums and psycho-oncology specialist psychiatrists or clinical psychologists. Talking about your experiences with people who understand what you are going through may also help. As a starting point, consider speaking to people around you whose experiences share a common story with yours.

Remember, there are no silly questions when it comes to your health. You should be very careful when making an informed decision.

It is normal to feel nervous discussing your treatment options and long-term outlook. Asking questions and expressing your concerns can help you obtain the information you need to feel confident in your choices. It can also help you prepare mentally and physically to begin treatment.