Treating symptoms of metastatic prostate cancer

Metastatic prostate cancer means that a cancer that began in the prostate has spread to another part of the body such as the bones. It is also known as advanced prostate cancer.

Symptoms of metastatic prostate cancer depend on where the cancer has spread to. Symptoms might include:

• tiredness and feeling unwell 
• bone pain 
• breathlessness 
• problems passing urine
• weight loss and loss of appetite 
• bowel problems 
• sexual problems such as difficulty getting an erection
• swelling

The symptoms can be difficult to cope with. But your doctors and nurses can support you and give you treatments to help relieve the symptoms.

Treatments such as chemotherapy, radiotherapy or hormone therapy might shrink the cancer, reduce symptoms and help you feel better. You can also have other medicines to help relieve symptoms, such as painkillers. 

Symptom control team or palliative care team

There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.

Most symptom control teams have home care services to visit you at home.

Treatment for tiredness and feeling unwell

Tiredness (fatigue) is a common symptom of advanced cancer. You may feel that you lack energy, and this can be overwhelming. 

Let your doctor or nurse know if you’re very tired, as they can prescribe medicine to help or other treatments to help. For example, a blood transfusion can give you more energy if you’re tired due to anaemia (low red blood cell levels).

Resting

It’s important to rest a few times throughout the day. Resting regularly can help you feel less tired and more able to cope. You don't have to sleep during these times. Just sitting or lying down will help. 

Exercise

Exercising can be hard when you feel very tired. But, research shows that daily light to moderate exercise can give you more energy. You can try a short walk if you can manage it. Gentle exercises in bed or standing up can help if you can’t move around easily. 

Your hospital physiotherapist might be able to help you plan an exercise programme that suits your needs.  

Sleeping

You might feel more tired if you have trouble sleeping at night. It can help to change a few things about when and where you sleep.

Treatment for bone problems

You might have bone pain if your cancer has spread to your bones. Your bones might be weaker, so they could break more easily.

Possible treatments include:

• hormone treatment
• external radiotherapy and a type of internal radiotherapy called radium 223
• surgery
• bisphosphonates
• radiofrequency ablation (RFA)
• painkillers

Treatment for breathlessness

You might feel breathless if your cancer has spread to your lungs or if you have low red blood cell levels (anaemia). You can learn breathing techniques that can help. You might need a blood transfusion to give you red blood cells if you have anaemia.

Tell your doctor or nurse if you feel breathless. They can prescribe medicines to make your breathing easier.

Treatment for problems passing urine

You might have problems passing wee (urine) if your cancer presses on the tube that carries urine from the bladder (urethra). Also, if your cancer spreads to your urethra and bladder this can make it difficult to pass urine. 

You might:

• pass urine more often
• need to get up in the night to pass urine
• have difficulty passing urine
• suddenly not be able to pass urine (acute urine retention)
• have a strong urge to empty your bladder
• have blood in your urine or semen
• have kidney problems
• leak urine (incontinence)

Treatments depend on the cause of the problem. You might: 

• have a tube into your bladder (catheter) to drain the urine
• take drugs called alpha blockers to help relax the muscles around the opening of the bladder
• have surgery to remove the inner part of the prostate to stop it blocking the flow of urine. This is called trans urethral resection of the prostate (TURP)
• do pelvic floor muscle exercises to strengthen the muscles that help you pass urine
• use pads or pants to absorb any urine leakage

If cancer blocks the tubes that drain urine from your kidney to your bladder (the ureters), you might have a tube put into your kidney to drain wee outside of your body or a stent put into the ureter to keep it open. Sometimes you might have radiotherapy to make the cancer smaller to relieve the blockage. 

Treatment for loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can.

Tips

• Eating several small meals and snacks throughout the day can be easier to manage.
• Ask your doctor to recommend high calorie drinks to sip between treatments if you are worried about losing weight.
• Eat whatever you feel like eating rather than what you think you should eat.
• Make up calories between treatments for the days when you really don’t feel like eating.
• Drink plenty of fluids even if you can't eat.
• Don't fill your stomach with a large amount of liquid before eating.
• Try to eat high calorie foods to keep your weight up.

Treatment for bowel problems

These include frequent or loose poo or a feeling that you have to rush to the toilet (urgency). If you’ve had radiotherapy you might feel the need to strain whether or not you need to poo.

You might have constipation if you’re taking certain painkillers or if you’re less active than usual. Speak to your doctor or nurse if you feel constipated.

Treating pressure on the spinal cord

Cancer that has spread into the spinal bones can cause pressure on the spinal cord. This is called spinal cord compression. The pressure on the spinal cord stops the nerves from working normally. This can cause:

• back pain
• changes in sensation, such as tingling or numbness
• changes in the way your bowel or bladder work
• difficulty walking

Treatment for sexual problems

Advanced prostate cancer can affect how you feel about yourself, your sex life and your relationships. You might have problems such as:

• difficulty getting an erection
• having less interest in sex
• changes in how your body looks and feels

If you have a partner it can be hard to cope if you can’t have sex. This can affect your self image and you might feel sad or depressed. Speak to your partner about your concerns. Keep in mind that you can still be intimate with them through cuddling and kissing.

Speak to your doctor or nurse about any sexual problems. They are used to discussing these issues and can offer support or refer you to a sex therapist.

Treatment for swelling (lymphoedema)

You might have swelling called lymphoedema if the cancer has spread to the lymph glands in the groin or pelvis. The swelling might be in:

• one or both legs
• the lower part of the tummy (abdomen)
• the genital area

Make sure you don’t get skin infections because these increase the risk of swelling.

Lymphoedema can be difficult to cope with. Lymphoedema practitioners can offer treatment and support. Speak to your doctor or nurse if you notice any swelling.

Coping with mood changes

You might find it difficult to cope when you are diagnosed with metastatic or advanced cancer.

It is common for people with metastatic prostate cancer to feel sad or become depressed. You may find it helpful to understand this as a part of your illness. Talk to your specialist nurse about how you are feeling. They can arrange for more support if you need it.