- Weight Loss and Prostate Cancer
- The Top 7 Signs of Advanced Prostate Cancer
- 1. Bladder and urinary troubles
- 2. Losing bowel control
- 3. Soreness in the groin
- 4. Leg swelling or weakness
- 5. Hip or back pain
- 6. Coughing or feeling out of breath
- 7. Unexplained weight loss
- The takeaway
- What is Advanced Prostate Cancer?
- What is hormone therapy?
- What is orchiectomy?
- LHRH or GnRH agonists and antagonists
- Combined androgen blockade (CAB)/anti-androgen therapy
- What is estrogen hormone therapy?
- Prostate cancer symptoms
- What to know about prostate cancer
Weight Loss and Prostate Cancer
Prostate cancer doesn’t affect just your prostate — it can take a toll on your whole body. As the disease progresses, for example, you may find that mouth sores make chewing and swallowing too painful, or that you simply have no appetite. As a result, you may lose weight, more than is healthy for someone battling prostate cancer.
Sufficient calorie intake and maintaining a healthy body weight are important to keep up your energy levels and keep your body physically strong. But that can be a challenge for prostate cancer patients.
Why Weight Loss Occurs During Prostate Cancer Treatment It’s not fully understood why prostate cancer patients often lose their appetite (the medical term for this is anorexia) during prostate cancer. It’s common for prostate cancer patients to lose weight during treatment because foods may taste different, or they just may not feel like eating.
When you’re not eating enough and feeling anxious about your prostate cancer prognosis and treatment, it’s easy to burn off calories and drop weight unintentionally. This kind of weight loss in cancer patients, if it is a significant amount, is also called cachexia. Both anorexia and cachexia are common during cancer treatment.
If you are experiencing nausea or vomiting as a side effect of treatment, those symptoms can often be controlled. Ask your doctor about how to control those side effects to prevent unwanted weight loss.
Increase Your Calories Prostate cancer patients “need to eat more often and more frequently, and just small handfuls of food,” says Kristina Ratley, RD, CSO, LDN, a dietitian on call at the American Cancer Society. “It doesn’t have to be a whole meal — it can be half a sandwich and milk, or half a sandwich and juice. Not to push the patient — just to encourage them and offer them food on a frequent basis. Sometimes when they eat a lot it makes them more uncomfortable, so that’s not benefiting the patient a lot.”
If you don’t feel like eating much, it’s important to get as many calories as possible into the meals that you are able to eat. Even though you might normally think it is healthy to avoid them, try to eat plenty of calorie-rich foods to prevent further weight loss.
- Flavor your food with calories. Try cooking with butter or oil, and add honey or brown sugar to foods for extra calories and taste.
- Get liquid nutrition. Try nutrient-supplemented drinks, soups, juice, milkshakes and smoothies if they are easier to swallow than solid foods.
- Snack. Eat plenty of calorie- and protein-rich snacks throughout the day.
- Choose high-calorie basics. Snack on cheese and crackers, pudding, yogurt, ice cream, and muffins. Spread foods with cream cheese or peanut butter for extra calories.
“Protein is a component that’s important for cancer patients, and protein sources could be the meat and the fish, but also eggs, cheese, cottage cheese, yogurt, milk,” Ratley says. “Protein indirectly may help them preserve some of the muscle mass … you are trying to avoid the breakdown of muscle mass.” White meats are a healthier source of protein for prostate cancer patients than red meats, and may taste better to them.
Getting Your Appetite Back Your appetite should come back after the prostate cancer treatment is finished, and once you’re eating more and are less anxious, the pounds should stop falling off. But do what you can to boost your appetite during treatment.
Caregivers can encourage prostate cancer patients to eat by stimulating their appetite with exercise.
“Try to do some type of exercise, even if it’s just walking out to the mailbox and back, depending on how severe the case is. Exercise tends to help stimulate the appetite,” Ratley says. “As a last resort, some patients can use appetite stimulants that are prescribed.”
Figure out which foods taste the best, and keep plenty on hand. Have lots of good-tasting, convenient foods and snacks available so that they’re easy to eat if you’re tired. Don’t make yourself sit down to a big meal; instead, snack throughout the day.
Cancer caregivers can also help in trying to encourage appetite. Offer to prepare meals for your loved one with prostate cancer, and try new foods. Don’t force the patient to eat, but offer encouragement if the patient is hungry. Try new ways to flavor food to make it taste better, and find additives to add calories.
Make mealtime fun again: Enjoy food with family, friends, and conversation. Ask your doctor if a small amount of wine or beer is allowed to kick your appetite into gear. Enjoying a pleasant mealtime can make nearly all foods more appealing.
The Top 7 Signs of Advanced Prostate Cancer
In the early stages, you may not notice any symptoms related to prostate cancer. This is why screenings are important. Symptoms can sometimes be noticed for the first time when the cancer advances.
Advanced prostate cancer, also called metastatic cancer, means the cancer has spread to other areas of your body beyond your prostate gland. The most common areas for prostate cancer to spread are your bladder, rectum, and bones. It can also spread to your lymph nodes, liver, lungs, and other body tissues.
Whether you’ve just been diagnosed or you’re in treatment, it’s also important to know the signs of advanced cancer. Cancer can behave differently depending on your genetics, so not every person will experience the same symptoms in the same way.
Read on to learn more about the seven top symptoms of advanced prostate cancer and how to spot them.
1. Bladder and urinary troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- having blood in your urine or semen
- feeling like you have to urinate often and not actually passing anything
- not being able to hold your urine (incontinence)
2. Losing bowel control
It’s not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer that’s spread to the bowels include:
- stomach pain
- blood in your stool
3. Soreness in the groin
When prostate cancer spreads, it’s common for cancer cells to go to your lymph nodes and then move to more areas of your body. (This is the same for other forms of cancer.) The lymph nodes are a network of glands that help your body filter fluids and fight infections.
There are several lymph nodes in your groin. These are the ones closest to your prostate, so it’s common for the cancer to spread to them first. Cancer cells prevent your lymph nodes from draining fluid and working properly. When this happens, your lymph nodes swell. As a result, you might experience pain or soreness in the area.
4. Leg swelling or weakness
Advanced cancer begins to crowd out other healthy cells in your body when it grows. Tumors can press on areas like your spinal cord and cause pain, tingling, or swelling in your legs and feet.
5. Hip or back pain
One of the most common areas for prostate cancer to spread is to the bones, often your hip and spine since these are closest to your prostate. When cancer reaches your bones, it starts to crowd out healthy bone material. Bones become brittle and can break much easier than they normally would.
Having cancer spread to your bones is painful and often requires treatment to manage the pain. You may feel a dull ache or stabbing pain that doesn’t go away and disrupts sleep or regular activities.
Back pain can be a sign of both cancer spreading to your bones or the beginning of pressure on your spinal cord. Spinal cord compression happens when cancer is pushing so hard against the spinal cord that the nerves can no longer work properly. This requires medical treatment, and your cancer team might talk to you about a plan ahead of time.
6. Coughing or feeling out of breath
If you have advanced cancer and begin to have trouble breathing, this could mean it has spread to your lungs. You might develop a cough that doesn’t go away, start coughing up blood, or become easily out of breath.
Cancer in your lungs can also lead to fluid buildup, causing infections and even a lung collapse.
7. Unexplained weight loss
Losing weight without eating less or actively trying to lose weight is a general sign of advanced cancer. This could be combined with some of the other signs above.
Loss of appetite or interest in eating is also a sign cancer has spread to other areas of your body, like your liver.
Even if your cancer has advanced, there are still a variety of treatment options available. People are able to live longer today than in years past because of advances in medical research. Treatments for advanced prostate cancer focus on managing symptoms and slowing the growth and spread of the cancer.
Your doctor knows the treatment options and tests, but you know your body. Make sure to communicate with your doctor and tell them about any changes you notice in your body at each visit.
What is Advanced Prostate Cancer?
What is hormone therapy?
Hormone therapy is any treatment that lowers the man’s androgen (male sex hormone) levels. For prostate cancer, it is any method to block testosterone. Because testosterone is the main fuel for prostate cancer cells, blocking it may slow the cancer.
There are several types of hormone therapy. Some treat prostate cancer that has spread beyond the prostate or is advanced.
Some health care providers may use other types of hormone therapy for earlier stage prostate cancer. Hormone therapy can shrink a local tumor to allow more effective radiation treatment. This helps with more aggressive localized cancer. Types of hormone therapy include:
- Surgery to remove the testicles (Orchiectomy)
- LHRH or GnRH agonists
- LHRH or GnRH antagonists
- Estrogen therapy
Who are good candidates for hormone therapy?
Men whose prostate cancer has metastasized (spread) outside the prostate are good candidates for hormone therapy. It is also used when prostate cancer has come back after surgery or radiation treatments.
What are the benefits, risks and side effects of hormone therapy?
Because hormone therapy can be used as cancer advances, this therapy is useful for cancer that has returned. But hormone therapy usually works for only a few years. Over time, the cancer can grow in spite of the low hormone level. Hormone therapy does not cure the cancer. It has side effects. And other treatments are often needed to manage the cancer.
Before starting any type of hormone therapy, talk with your health care provider. Learn about the effects of testosterone loss. Low dose or intermittent (not constant) hormone therapy may lessen side effects.
Possible side effects include:
Lower libido (sexual desire) in 90% of men
Erectile dysfunction (inability to have or keep a strong enough erection for sex)
Hot flashes (sudden spread of warmth to the face, neck and upper body, heavy sweating). Hot flashes are not a health risk. Medicines can control them.
Weight gain of 10 to 15 pounds. Diet, lower carbohydrate intake and exercise can help.
Depression caused by the treatment, reaction to side effects, or other cancer-related issues. Symptoms include loss of hope and loss of interest in usually enjoyable activities. Other symptoms include not being able to concentrate and changes in appetite and sleeping.
Fatigue (tiredness) that doesn’t go away with rest or sleep, caused by lower testosterone
Anemia (low red blood cell count). Less oxygen gets to tissues and organs, causing tiredness or weakness. It can be treated with medicines, vitamins and minerals.
Loss of muscle mass. This may cause weakness or low strength. Progressive weight-bearing exercise help improve strength.
Osteoporosis (loss of bone mineral density). This means bones become thinner, brittle and break easier. It can be treated with medicines, calcium and vitamin D. Progressive weight-bearing exercise help strengthen bones.
High cholesterol, especially LDL (“bad”) cholesterol
Breast nipple tenderness
Increased risk of diabetes, 40% higher compared to men not on ADT
Heart disease. Some studies show men on ADT are at higher risk for heart problems. Others have not shown this. The effect of ADT on the heart is still unknown.
What is orchiectomy?
Orchiectomy is surgery to remove the testicles. It is also called castration. The testicles make most of the body’s testosterone. Orchiectomy is a type of hormone therapy because removing the testicles stops the body from making the male hormone, testosterone.
Orchiectomy is fairly simple surgery. It is usually done as an outpatient. The surgeon makes a small cut in the scrotum (sac that holds the testicles). The testicles are detached from blood vessels and removed. The vas deferens (tube that carries sperm to the prostate before ejaculation) is removed. Then the sac is sewn up.
What are the benefits, risks and side effects of orchiectomy?
There are multiple benefits to undergoing orchiectomy treat advanced prostate cancer. It is not expensive. It is simple and has few risks. It only needs to be performed once. It is effective right away. Testosterone levels drop dramatically. There is often fast relief from cancer symptoms.
The main risks are infection and bleeding. Death is a risk of all surgery with general anesthesia. But death is extremely rare with castration. Many men are very uncomfortable with this surgery because it is not reversible. Concerns about body image or self-image may lead men to choose another treatment.
Removing the testicles means the body stops making testosterone. This causes the side effects listed above for hormone therapy. Castration may also have a psychological effect. The look of the genital area and lack of testicles may affect self-image. Some men choose to have artificial testicles or saline implants placed in the scrotum. This makes the scrotum look the same as before surgery.
Another surgery choice is subcapsular orchiectomy. This removes the glands around the testicles. But it leaves the testicles themselves. The scrotum looks normal.
Who are good candidates for orchiectomy?
Men who choose this therapy want a one-time surgical treatment. They must be healthy enough to have surgery. And they must be willing to have their testicles permanently removed.
LHRH or GnRH agonists and antagonists
These are the first and second treatment choices for localized cancer and cancer that has come back.
LHRH or GnRH agonists
This hormone therapy is usually the first treatment for localized cancer. It is also used for cancer that has come back, whether or not it has spread. Possible agonists used include:
- Lupron (Leuprolide)
- Zoladex (Goserelin)
- Trelstar (Triptorelin)
- Vantas (Histrelin)
LHRH or GnRH agonists are man-made, powerful versions of natural LHRH hormone. Your body makes natural LHRH in your hypothalamus. LHRH causes your body to make luteinizing hormone (LH). LH then causes your body to make testosterone.
With LHRH therapy, you are given man-made LHRH. Your body then makes more LH. Testosterone levels rise. Your prostate and prostate cancer cells grow, causing bone pain. This is called a “flare up.” It lasts 7-10 days. Your body then stops making any new natural LHRH. That causes your body to stop making new LH and testosterone.
Your testosterone levels drop by 90-95%. This is called the “castrate level.” It’s the same as if your testicles were gone. Once testosterone levels drop, prostate cells and cancer cells stop growing. This is because testosterone is not fueling their growth.
LHRH or GnRH antagonists
This is the second line of treatment for localized cancer or cancer that has come back. LHRH or GnRH antagonists interfere with brain signals. This blocks the release of natural LH. When LH isn’t released, your body stops making testosterone. The drug used is Firmagon (degarelix).
Antagonists usually do not produce the hormonal “flare up” seen often with agonists. There is no short-term testosterone boost when you begin this therapy.
Antagonists are injected (shot) in the buttocks every month. It is done in the health care provider’s office. You will stay in the office awhile after the shot. This is to make sure there is no allergic reaction. After the first shot, a blood test makes sure testosterone levels have dropped. You may also have tests to monitor bone density.
What are the benefits, risks and side effects of LHRH or GnRH treatment?
With LHRH treatment you must go to your health care provider every month or two for injections. Your health care provider will also need to check side effects and PSA levels. The PSA test will tell if the cancer has slowed.
With LHRH treatment there is no need for an orchiectomy (surgery). Side effects may be reversible. This depends on the length of time you are on treatment.
The main disadvantage to LHRH treatment is the cost. The injections together are more expensive than a one-time surgery. The cost may be a burden if health insurance does not cover the treatment.
Side effects include the “flare up” from the agonist treatment, bone pain and possible irreversible loss of the body’s ability to make testosterone.
Who are good candidates for LHRH treatment?
Men who cannot or do not wish to have surgical removal of the testicles are good candidates for these treatments.
Combined androgen blockade (CAB)/anti-androgen therapy
This treatment is only used when first line LHRH agonist and LHRH antagonist treatment did not work. Or the drugs are not working by themselves. It is used for castration resistant prostate cancer that is non-metastatic (is not spreading).
What is combined androgen blockade (CAB)/anti-androgen therapy?
This treatment combines castration and anti-androgen therapy. Castration is either by surgery or by using hormones to stop your body from making testosterone.
The treatment stops testosterone by blocking the androgen receptors in the prostate cells. Normally, testosterone would bind with these receptors. This fuels growth of prostate cancer cells. With the receptors blocked, testosterone cannot “feed” the prostate. Anti-androgen therapy does not lower testosterone. So it may have fewer or milder side effects than surgery and medical hormone treatment.
These are the three most common anti-androgen drugs used as second line treatment for non-metastatic prostate cancer growth:
The drug is taken as a tablet or pill. A single dose usually has 50 mg to 150 mg. You should take the drug around the same time every day. This keeps a steady level of the drug in your body. If you forget to take a dose you should not take a double dose. Taking a dose the same time each day also lowers side effects like nausea or vomiting.
What are the benefits, risks and side effects of CAB/anti-androgen therapy?
Using anti-androgens a few weeks before LHRH therapy reduces painful and potentially dangerous “flare ups.” Anti-androgens are also used after surgery or castration when hormone therapy stops working. A few studies show anti-androgens alone may not work as well as medical or surgical castration alone. Other studies found no difference in survival rates of people who used only one form of treatment.
Who are good candidates for CAB/anti-androgen therapy?
You and your doctor will weigh the benefits and risks of this therapy against other treatments. Whether this therapy is a good choice for you depends partly on where the cancer has spread and its effects.
What is estrogen hormone therapy?
Estrogens are female sex hormones. They can be used to block testosterone production in the testicles.
What are the risks, benefits and side effects of estrogen hormones?
Estrogen hormone therapy has side effects similar to androgen hormone therapy. But the use of estrogens may cause female sex characteristics to develop. This may include breast tenderness and swelling and other changes.
Who are good candidates for estrogen hormone therapy?
Because of the side effects of estrogen hormone therapy, it is not often used today.
New hormone therapies for mCRPC, advanced prostate cancer that has metastasized (spread)
Scientists have made new discoveries in how to treat metastatic CRPC (mCRPC). There are new treatments for mCRPC. And changes are being made to make existing treatments work better.
If you are diagnosed with mCRPC, your health care provider may prescribe one of these treatments to help you. Treatments may help you delay symptoms and live longer:
Androgen synthesis inhibitors
Abiraterone acetate (Zytiga®) is a drug you take as a pill. It stops your body and the cancer from making steroids (including testosterone). Because of the way it works, this drug must be taken with an oral steroid called Prednisone. Abiraterone may be used before or after chemotherapy in men with mCRPC.
Androgen receptor binding inhibitors
Enzalutamide (Xtandi®) is a drug that blocks testosterone from binding to the prostate cancer cells. Because it works differently than Abiraterone , you do not need to take a steroid with this drug. It is taken as a pill. Enzalutamide (Xtandi®) may be used in men with mCRPC before or after chemotherapy.
Updated August 2018
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What to know about prostate cancer
Treatment will depend on the stage of the cancer, among other factors.
In the sections below, we list some treatment options for each stage of prostate cancer, as well as some new approaches and what treatment means for fertility:
Early stage prostate cancer
Share on PinterestA prostatectomy is one possible treatment for early stage prostate cancer.
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action.
Prostate cancer grows slowly, and the risk of side effects may outweigh the need for immediate treatment.
A surgeon may carry out a prostatectomy. They can remove the prostate gland using either laparoscopic or open surgery.
Brachytherapy: A doctor will implant radioactive seeds into the prostate to deliver targeted radiation treatment.
Conformal radiation therapy: This targets a specific area, minimizing the risk to healthy tissue. Another type, called intensity modulated radiation therapy, uses beams with variable intensity.
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
Advanced prostate cancer
As cancer grows, it can spread throughout the body. If it spreads, or if it comes back after remission, the treatment options will change.
Chemotherapy: This can kill cancer cells around the body, but it can cause adverse effects.
Hormonal therapy: Androgens are male hormones. The main androgens are testosterone and dihydrotestosterone. Blocking or reducing these hormones appears to stop or delay the growth of cancer cells. One option is to undergo surgery to remove the testicles, which produce most of the body’s hormones. Various drugs can also help.
Lupron is a kind of hormone therapy that doctors use to treat prostate cancer. What does this treatment involve?
Most doctors do not recommend surgery in the later stages, as it does not treat cancer that has spread to other parts of the body. However, some experts have suggested that it may help in some cases.
Some newer approaches aim to treat prostate cancer without the side effects that other treatment options can bring.
- high intensity focused ultrasound
After surgery, a doctor will continue to monitor PSA levels. Learn more here about what to expect.
Effects on fertility
The prostate gland plays a role in sexual reproduction. Prostate cancer and many of its treatments affect fertility in several ways.
For example, if a male has surgery to remove either the prostate gland or the testicles, it will affect semen production and fertility.
Also, radiation therapy can affect prostate tissue, damaging sperm and reducing the amount of semen for transporting it.
Hormonal treatment can also affect fertility.
However, some options for preserving these functions include:
- banking sperm before surgery
- extracting sperm directly from the testicles for artificial insemination
However, there is no guarantee that fertility will remain intact after treatment for prostate cancer. Anyone who would like to have children after treatment should discuss fertility options with their doctor when they devise their treatment plan.