Prostate cancer and fatigue

Prostate Cancer Treatment and Fighting Fatigue

Men diagnosed with prostate cancer may experience serious fatigue — and cancer fatigue is more than feeling a little tired, sleepy, or just not having as much energy as usual. Fatigue can be a serious side effect of prostate cancer and its treatments. But the good news is that there are plenty of ways to manage your prostate cancer fatigue.

Why Prostate Cancer Fatigue Happens When you’re being treated for prostate cancer, your body is dealing with an enormous amount of physical changes and problems. Any one of them by itself, and all of them together, can cause prostate cancer fatigue.

  • Physical and emotional pain. If your body is coping with pain from prostate cancer and prostate cancer treatment, fatigue is common. Anxiety and stress can also cause you to feel fatigued, and these are common side effects of prostate cancer.
  • Not getting enough sleep or exercise. These are common problems in prostate cancer patients.
  • Poor diet. This may be because you aren’t getting the healthy foods you need, or because treatment makes it difficult to eat.
  • Changes in hormones. Prostate cancer treatments can affect your hormone levels, which can lead to fatigue.
  • Anemia. Having a low red blood cell count is a common side effect of some prostate cancer treatments.
  • Medicine. The medication you are taking to treat prostate cancer or to decrease other side effects can make you feel fatigued.

Managing Prostate Cancer Fatigue There may be many causes of cancer fatigue, but you don’t have to accept this feeling. Many things can boost your energy levels and help you feel like yourself again.

Keep moving. “The main thing is to try to continue to work through it. Try to remain as active as possible. It seems as though those men who remain active throughout their treatment end up in the long term feeling better and dealing with all sorts of side effects and issues,” says Durado Brooks, MD, director of prostate and colorectal cancer at the American Cancer Society.

Don’t be a couch potato. Don’t be a couch potato. It’s important for prostate cancer patients to avoid the temptation to nap and watch TV, Dr. Brooks says. His recommendation? “Make yourself get up and get moving, if nothing other than just walking around in your yard. If possible, try getting out, getting some sort of regular activity on a regular basis. Take walks, ride bikes — try to maintain as normal an activity level as possible,” Brooks says. One recent study from New Zealand found that prostate cancer patients who got regular exercise experienced less fatigue and better overall quality of life.

Get some sleep. Brooks also recommends making sure you’re getting plenty of rest. Your body is busy fighting off cancer, so it needs sleep. But get most of your sleep at night: A little power nap here or there is okay, but don’t nap for too long during the day or it can keep you up at night. “If you’re having trouble sleeping, talk to your doctor about whether a mild sedative might be helpful,” Brooks says.

Stay well-nourished. Besides good sleep and regular exercise, there are other ways to help yourself feel more energized. It’s always important to keep yourself well-hydrated with plenty of fluids and eat nutritious foods — as many fruits and vegetables as you can eat.

Conserve your energy. Save your energy for when you know it will be needed. Take breaks, skip activities that aren’t necessary, and make life easier on yourself. Don’t stand up too long, and don’t brave very hot or very cold temperatures. Don’t expect to be able to do everything that you did before you started prostate cancer treatment. Ask friends and family members to help with such chores as washing the car, yard work, or cleaning the house.

Don’t just accept the fatigue. Take your doctor’s advice, and you’ll feel better and stronger.

Fatigue for someone who has prostate cancer (PC) is much more than just feeling tired and it’s not something that can be remedied with a good night’s sleep. Fatigue can be completely debilitating and many men cite it as one of the worst things about having prostate cancer MORE: Six symptoms of chronic fatigue Fatigue with prostate cancer is often caused by a combination of elements. Treatments like chemotherapy and radiation therapy can zap energy, coupled with the stress and anxiety of having cancer, it’s little wonder that many prostate cancer patients suffer from the symptom. However, it’s possible to manage fatigue according to Prostate Cancer UK. Ensuring that you try to live as healthily as possible — eating well, sleeping well, drinking plenty of water, and gentle exercise — can help to lessen the effects of fatigue. Conserving energy when you’re feeling fatigued and only doing the bare minimum will help ease feelings of exhaustion. Planning ahead will help you ensure you don’t overload your schedule. Lean on those around you for support and if fatigue is affecting your job, ask your boss if you can work from home or change your hours so you’re working at a more suitable time. Prioritize what needs to be done and what can be left or delegated to others. Look for ways to make chores or tasks easier — sitting down instead of standing or tackling jobs in segments rather than doing it all at once. If depression or anxiety is contributing towards fatigue, it’s important to have these issues addressed. Counseling can help many men going through prostate cancer and your doctor may be able to p Subscribe or log in to access all post and page content.

Fatigue

What is fatigue?

Fatigue is a lingering feeling of tiredness that prevents you from participating in your daily activities. This is not the same feeling of tiredness caused from extreme exercise or over exertion.

What causes fatigue?

Many men experience fatigue as a side effect of androgen deprivation therapy or chemotherapy. However, there are several causes of fatigue.

Tell your doctor if you are feeling fatigued. Together, you can work to find out the cause and plan a management strategy for your fatigue.

How can I manage fatigue?

Generally fatigue will begin to decrease as time progresses. However, some people will have to cope with it for an extended period of time. Here are some tips on managing your fatigue:

  • Eat a nutritious diet
  • Set realistic goals for what you want to accomplish each day
  • What time of day do you have the most energy? Try to schedule high-effort activities during that time
  • Try to get eight hours of sleep each night
  • Take time to rest during the day as you need
  • Try to be physically active, start slowly and work up to a comfortable level
  • Ask for and allow others to help you
  • Alibhai SMH, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit Rev Oncol Hematol. 2006 Dec;60(3):201–15.
  • Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2016 Apr;69(4):693–703.
  • Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, et al. Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation. J Clin Oncol. 2014 Jun 10;32(17):1840–50.
  • Bower JE. Cancer-related fatigue—mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014 Aug 12;11(10):597–609.
  • Buckley BS, Lapitan MCM. Prevalence of Urinary Incontinence in Men, Women, and Children—Current Evidence: Findings of the Fourth International Consultation on Incontinence. Urology. 2010 Aug;76(2):265–70.
  • Campo RA, Agarwal N, LaStayo PC, O’Connor K, Pappas L, Boucher KM, et al. Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of Qigong. J Cancer Surviv. 2014 Mar;8(1):60–9.
  • Christie Hospital NHS Foundation Trust. Be active, stay active: A guide for exercising during and after treatment for cancer. 2008.
  • Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults.
  • The Cochrane Collaboration, editor. Cochrane Database Syst Rev . 2012 Nov 14; Available from: http://doi.wiley.com/10.1002/14651858.CD006145.pub3
  • Dason S. Intermittent androgen deprivation therapy for prostate cancer:translating randomized controlled trials into clinical practice. Can J Urol. 2014;21(Suppl 1):28–36.
  • de Boer AGEM, Verbeek JHAM, Spelten ER, Uitterhoeve ALJ, Ansink AC, de Reijke TM, et al. Work ability and return-to-work in cancer patients. Br J Cancer. 2008 Mar 18;98(8):1342–7.
  • Doyle-Lindrud S. Managing Side Effects of the Novel Taxane Cabazitaxel in Castrate-Resistant Prostate Cancer. Clin J Oncol Nurs. 2012 Jun 1;16(3):286–91.
  • Eastham JA. Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol. 2007 Jan;177(1):17–24.
    Equality Act 2010.
  • Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined Resistance and Aerobic Exercise Program Reverses Muscle Loss in Men Undergoing Androgen Suppression Therapy for Prostate Cancer Without Bone Metastases: A Randomized Controlled Trial. J Clin Oncol. 2010 Jan 10;28(2):340–7.
  • Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol. 2014 Feb 1;32(4):335–46.
  • Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113–24.
  • Garrett K, Dhruva A, Koetters T, West C, Paul SM, Dunn LB, et al. Differences in Sleep Disturbance and Fatigue Between Patients with Breast and Prostate Cancer at the Initiation of Radiation Therapy. J Pain Symptom Manage. 2011 Aug;42(2):239–50.
  • Harden J. Developmental life stage and couples’ experiences with prostate cancer: a review of the literature. Cancer Nurs. 2005 Apr;28(2):85–98.
  • Harden JK, Northouse LL, Mood DW. Qualitative analysis of couples’ experience with prostate cancer by age cohort. Cancer Nurs. 2006 Oct;29(5):367–77.
  • HMSO. Disability Discrimination Act 1995.
    Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-Related Fatigue: The Scale of the Problem. The Oncologist. 2007 May 1;12(suppl_1):4–10.
  • Horneber M, Fischer I, Dimeo F, Ruffer JU, Weis J. Cancer-Related Fatigue. Dtsch Arztebl Int. 2012 Mar;109(9):161–71.
  • Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. J Pain Symptom Manage. 2012 Jan;43(1):96–110.
  • Koornstra RHT, Peters M, Donofrio S, van den Borne B, de Jong FA. Management of fatigue in patients with cancer – A practical overview. Cancer Treat Rev. 2014 Jul;40(6):791–9.
  • Kurzrock R. The role of cytokines in cancer-related fatigue. Cancer. 2001;92(S6):1684–1688.
  • Kyrdalen AE, Dahl AA, Hernes E, Cvancarova M, Foss\aa SD. Fatigue in hormone-naive prostate cancer patients treated with radical prostatectomy or definitive radiotherapy. Prostate Cancer Prostatic Dis. 2010;13(2):144–150.
  • Kyrdalen AE, Dahl AA, Hernes E, Hem E, Fosså SD. Fatigue in prostate cancer survivors treated with definitive radiotherapy and LHRH analogs. The Prostate. 2010 Sep 15;70(13):1480–9.
    Langston B, Armes J, Levy A, Tidey E, Ream E. The prevalence and severity of fatigue in men with prostate cancer: a systematic review of the literature. Support Care Cancer. 2013 Jun;21(6):1761–71.
  • Larkin D, Lopez V, Aromataris E. Managing cancer-related fatigue in men with prostate cancer: A systematic review of non-pharmacological interventions: Managing prostate cancer fatigue. Int J Nurs Pract. 2014 Oct;20(5):549–60.
  • Macmillan Cancer Support. Your rights at work . 2013 . Available from: http://www.macmillan.org.uk/Documents/Cancerinfo/Livingwithandaftercancer/WorkandcancerPDFs/Yourrightsatwork_2013_2.pdf
  • Merriman JD, Dodd M, Lee K, Paul SM, Cooper BA, Aouizerat BE, et al. Differences in Self-reported Attentional Fatigue Between Patients With Breast and Prostate Cancer at the Initiation of Radiation Therapy: Cancer Nurs. 2011 Sep;34(5):345–53.
  • Miles L. Physical activity and health. Nutr Bull. 2007;32(4):314–363.
    Minton O, Jo F, Jane M. The role of behavioural modification and exercise in the management of cancer-related fatigue to reduce its impact during and after cancer treatment. Acta Oncol. 2015 May;54(5):581–6.
  • Morrow GR. Cancer-Related Fatigue: Causes, Consequences, and Management. The Oncologist. 2007 May 1;12(suppl_1):1–3.
  • Mottet N, Bellmunt J, Briers E, Bolla M, Cornford P, De Santis M, et al. Guidelines on prostate cancer. European Association of Urology; 2016.
    National Institute for Clinical Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
  • National Institute for Health and Care Excellence. Physical activity: exercise referral schemes (PH54). 2014.
  • Pachman DR, Price KA, Carey EC. Nonpharmacologic approach to fatigue in patients with cancer. Cancer J. 2014;20(5):313–318.
  • Page MS, Berger AM, Johnson LB. Putting Evidence Into Practice: Evidence-Based Interventions for Sleep-Wake Disturbances. Clin J Oncol Nurs. 2006 Dec 1;10(6):753–67.
  • Pirl WF, Greer JA, Goode M, Smith MR. Prospective study of depression and fatigue in men with advanced prostate cancer receiving hormone therapy. Psychooncology. 2008 Feb;17(2):148–53.
  • Ryan J, Carroll J, Ryan E, Mustian K, Fiscella K, Morrow G. Mechanisms of Cancer-Related Fatigue. The Oncologist. 2007 May;12:22–34.
    Sanofi-Aventis. TAXOTERE® (docetaxel) Injection Concentrate – Prescribing Information. 2014.
  • Singer EA, Srinivasan R. Intravenous therapies for castration-resistant prostate cancer: Toxicities and adverse events. Urol Oncol Semin Orig Investig. 2012 Jul;30(4):S15–9.
  • Stone P, Hardy J, Huddart R, A’Hern R, Richards M. Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer. 2000;36(9):1134–1141.
  • Storey DJ, McLaren DB, Atkinson MA, Butcher I, Frew LC, Smyth JF, et al. Clinically relevant fatigue in men with hormone-sensitive prostate cancer on long-term androgen deprivation therapy. Ann Oncol. 2012;23(6):1542–9.
  • Storey DJ, McLaren DB, Atkinson MA, Butcher I, Liggatt S, O’Dea R, et al. Clinically relevant fatigue in recurrence-free prostate cancer survivors. Ann Oncol. 2012 Jan 1;23(1):65–72.
    The Disability Discrimination (Northern Ireland) Order. 2006.
  • Thompson JC, Wood J, Feuer D. Prostate cancer: palliative care and pain relief. Br Med Bull. 2007;83(1):341–54.
  • Truong PT, Gaul CA, McDonald RE, Petersen RB, Jones SO, Alexander AS, et al. Prospective evaluation of a 12-week walking exercise program and its effect on fatigue in prostate cancer patients undergoing radical external beam radiotherapy. Am J Clin Oncol. 2011;34(4):350–355.
  • Wang XS. Pathophysiology of Cancer-Related Fatigue. Clin J Oncol Nurs. 2008 Jan 1;12(0):11–20.

Understanding Advanced (Stage 4) Prostate Cancer

No matter where prostate cancer spreads, it’s still treated as prostate cancer. It’s harder to treat when it reaches an advanced stage.

Treatment for advanced prostate cancer involves targeted and systemic therapies. Most men need a combination of treatments and they may have to be adjusted from time to time.

Hormone Therapy

Hormone therapy suppresses male hormones that help prostate cancer cells to grow. Your doctor may recommend any of the following hormone therapies:

  • Orchiectomy is a surgical procedure to remove the testicles, which is where the hormones are produced.
  • Luteinizing hormone-releasing hormone agonists are drugs that lower testosterone production in the testicles. You can receive these drugs by injection or by or by implantation under your skin.
  • LHRH antagonists are drugs that rapidly lower testosterone levels. You can receive these drugs by monthly injections under your skin.
  • CYP17 inhibitors and anti-androgens are available as pills you can take daily.

Side effects of hormone therapy drugs include injection site reactions, sexual dysfunction, and anemia.

Radiation

In external beam radiation, beams of radiation target the prostate gland or another area of the body. It can help to ease symptoms when prostate cancer has spread to bone. Fatigue is a common side effect.

For internal radiation, your doctor will implant tiny radioactive seeds into your prostate. The seeds emit a permanent low dose or temporary high dose of radiation. Potential side effects include sexual dysfunction, urinary difficulties, and bowel problems.

Chemotherapy

Chemotherapy kills cancer cells throughout the body. It may shrink existing tumors and slow or prevent the growth of new tumors. Side effects include nausea, loss of appetite, and weight loss.

Immunotherapy

Sipuleucel-T (Provenge) is a vaccine doctors use to treat advanced prostate cancer, especially if it’s not responding to hormone therapy.

The vaccine is made using your own white blood cells. You receive it intravenously in three doses spaced two weeks apart. Side effects may include:

  • nausea
  • a headache
  • back pain
  • joint pain

Surgery

While some surgery to remove tumors may be an option, your doctor is less likely to recommend it for prostate cancer that has spread to multiple areas.

Be sure to tell your doctor if some of these treatments are impacting your quality of life. You can also ask about clinical trials for prostate cancer. These trials involve newer treatments that aren’t yet in use.

In addition to treating the cancer, your doctor may be able to offer solutions for specific symptoms like pain, fatigue, and urinary problems.

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