- Jason Hu
Surviving prostate cancer: living in the aftermath of treatment
When talking about men’s cancers, there is no doubt that prostate cancer strikes a lot of fear as it is the most commonly diagnosed cancer in Canadian men. How common? One in eight men will develop the disease over the course of their lifetime. Fortunately, most patients live a long time, as most prostate cancers diagnosed today are slow growing. In fact, the 5-year and 10-year survival rates are at 96% and 93%, respectively. In other words, a lot of men are long-term survivors of the disease.However, they will have survivorship needs relating to specific health and psychological issues, caused not only by the cancer, but also from the treatment itself. You see, the cancer journey doesn’t end after treatment.
A recent survey done on prostate cancer survivors in the United Kingdom revealed that many men do not feel properly supported by their medical team after treatment and 1 in 3 did not think they were monitored enough for treatment side effects. So, what are the concerns of prostate cancer survivors?
Many prostate cancer patients have other significant health problems, including heart disease, diabetes, arthritis, osteoporosis and asthma, among others. This is unsurprising as prostate cancer is usually diagnosed in older men and these medical problems are typical of an older population. Therefore, it is important to monitor the general health status in all prostate cancer patients, particularly heart disease. Why? Although prostate cancer takes many lives, many prostate cancer survivors will ultimately die from non-cancer causes, with heart disease leading the way.
Treatments for prostate cancer can include removing the entire prostate through surgery, as well as different forms of radiotherapy. Problems of uncontrollable urine leakage and issues having an erection can arise in men who have their entire prostate removed. Men who are treated with radiotherapy can also suffer from these issues but they are not as frequent as in men who have their prostates removed. On the other hand, radiotherapy can lead to difficulties with urinating and bowel problems, with bloody stools being the most common trouble.
For men who use hormone therapy, some common side effects include hot flashes, loss of sex drive, problems having an erection, weight gain and muscle loss. When used for a long time, it has also been associated with a higher risk of heart problems, diabetes and bone fractures.
On the psychological side, many prostate cancer patients are also diagnosed with depression and anxiety either before, during or after treatment. Almost a quarter of all patients have clinical depression or anxiety over the course of their prostate cancer experience with it being highest between diagnosis and treatment.
While all these issues seem to paint a negative picture, survivors can do several things to tip the situation in their favour. The American Cancer Society released the Prostate Cancer Survivorship Care Guidelines, endorsed by the American Society of Clinical Oncology.
They recommend general ideas of health promotion which include regular exercise and eating fruits, vegetables, and whole grain foods. Some studies have shown that exercise can improve quality of life in prostate cancer patients. Finally, smoking has been linked with a greater chance of the cancer returning so saying goodbye to this bad habit is always recommended.
While there is a lot of talk about the impact of exercise and diet for preventing cancer, there is increasing evidence that they may improve the quality of life of cancer survivors. In addition, these healthy lifestyle behaviors are useful in fighting heart disease as well. It should be said that issues concerning prostate cancer survivorship are increasingly the subject of research and interest of doctors given the large number of prostate cancer survivors. One notable Canadian urologist from Sunnybrook, Dr. Laurence Klotz, is recognized internationally for his research on ways to reduce the burden of treatment side effects such as active surveillance and intermittent hormonal therapy.
Canadian Cancer Society's Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2015. Toronto, ON: Canadian Cancer Society, 2015.
Prostate Cancer UK. Men’s Views on Quality Care in Prostate Cancer: What does Quality Care Mean for Men with Prostate Cancer? National survey report. 2012.
Elliott J, Fallows A, Staetsky L, Smith PW, Foster CL, Maher EJ, et al. The health and well-being of cancer survivors in the UK: findings from a population-based survey. British journal of cancer. 2011;105 Suppl 1:S11-20.
Resnick MJ, Lacchetti C, Bergman J, Hauke RJ, Hoffman KE, Kungel TM, et al. Prostate cancer survivorship care guideline: American Society of Clinical Oncology Clinical Practice Guideline endorsement. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015;33(9):1078-85.
Epstein MM, Edgren G, Rider JR, Mucci LA, Adami HO. Temporal trends in cause of death among Swedish and US men with prostate cancer. Journal of the National Cancer Institute. 2012;104(17):1335-42.
Boorjian SA, Eastham JA, Graefen M, Guillonneau B, Karnes RJ, Moul JW, et al. A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes. European urology. 2012;61(4):664-75.
Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. The New England journal of medicine. 2016;375(15):1425-37.
Levine GN, D'Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, et al. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Circulation. 2010;121(6):833-40.
Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of fracture after androgen deprivation for prostate cancer. The New England journal of medicine. 2005;352(2):154-64.
Keating NL, O'Malley AJ, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. Journal of the National Cancer Institute. 2010;102(1):39-46.
Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901.
Farris MS, Kopciuk KA, Courneya KS, McGregor SE, Wang Q, Friedenreich CM. Associations of Postdiagnosis Physical Activity and Change from Prediagnosis Physical Activity with Quality of Life in Prostate Cancer Survivors. Cancer Epidemiol Biomarkers Prev. 2017;26(2):179-87.
Moreira DM, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, et al. Cigarette smoking is associated with an increased risk of biochemical disease recurrence, metastasis, castration-resistant prostate cancer, and mortality after radical prostatectomy: results from the SEARCH database. Cancer. 2014;120(2):197-204.