What is it?

Fatigue is the most common symptom reported by people with cancer and it can be acute or chronic. Some of the common symptoms include:

• Sleeping more than usual, or still feeling exhausted after a good night’s sleep
• Tiring quickly during activities, or having lower energy all of the time
• Changes in your emotions (like irritability or mood swings), or a general loss of interest in life
• Trouble concentrating, thinking, or remembering

While feeling tired may seem like a minor inconvenience compared to some of the other issues you experience, it can have a serious impact on your day-to-day activities and quality of life.

Fatigue facts

Studies of prostate cancer patients have found that:

• As many as 74% of prostate cancer patients experienced cancer-related fatigue
• Fatigue is associated with all treatments for prostate cancer

What causes it?

There are many factors that can contribute to fatigue when someone is going through cancer treatment. Some of the common reasons include:

Cancer and cancer treatment

Cancer itself can cause changes in your body, like increasing its need for energy. Chemotherapy and radiation therapy may also cause fatigue as your body works to repair your damaged non-cancerous cells. Treatments that cause side effects like anemia and pain, or that affect your hormones, can also contribute to fatigue.

Poor nutrition

When you have cancer, your body’s need for nutrients and its ability to process those nutrients may change. However, side effects like low appetite, nausea and vomiting can make it difficult to meet your nutrient needs.

Lack of exercise

If you’re normally an active person, the effects of fatigue can feel more pronounced because you don’t have the energy to maintain your usual level of physical activity.

Tips for managing it

Get enough sleep

Keep a regular routine to help you get a good night’s sleep. Do things that relax you leading up to bed time, and make sure your bed, pillows and sheets are comfortable. Avoid sleeping too much during the day as this can make you feel more tired.

Save your energy

Note when your energy is high, and plan activities and appointments around those times of day. You may need to be active for shorter periods, and don’t forget to plan rests as well.

Ask for help

Your family and friends are there to support you, so don’t be shy about taking them up on offers to help. Cooking, chores, driving and helping with pets are just some of the simple ways they can help.

Exercise

Regular exercise (both aerobic and weight training) can help improve your energy levels and reduce fatigue – even something as simple as walking. Be sure to check with your doctor before starting or changing your exercise program.

Eat right

Eat a well-balanced diet and drink plenty of fluids, especially when your energy and appetite are good. In between, try to snack every 2-3 hours.

Manage your mood

Depression and anxiety can increase your feelings of fatigue. Consult our Side effect section on how to look after your emotional well-being.

Work with your healthcare team

If your fatigue has a specific cause, your healthcare team can take steps to treat it, such as nutritional supplements, medicines or blood transfusions, so always keep them up to date on how you’re feeling.

What is it?

Erectile dysfunction (ED) is the inability to get and keep an erection firm enough to have sexual intercourse – even though you can still experience pleasure and have an orgasm. ED is a common side effect of prostate cancer treatments, including surgery (radical prostatectomy), radiation therapy and hormone therapy. Depending on your type of treatment and your age, your ED may be permanent or temporary.

Tips for managing it

If you have ED as the result of prostate cancer treatment, it can be yet another source of frustration in your life. But there are a few ways you can help gain control over your situation:

Don’t give up

Don’t assume you have a permanent problem and nothing can be done. Depending on your treatment you may recover your erectile function, but it can take a long time. In the meantime, try to control your anxiety around sexual encounters and activity, which can make ED worse.

Involve your partner

Honest and open communication can help make sure they know that this isn’t a sign of diminished interest in them, and can help you explore other ways to satisfy one another. Treatment is often more successful when a man involves his partner.

Manage your mood

Stress, anxiety and depression can seriously impact intimacy and erectile function. Be open with your healthcare team about all the issues surrounding your treatment and recovery.

Work with your healthcare team

Depending on the cause of your ED your healthcare team has several options to help you achieve erections, including:

• Medications (including pills, injections, and medicated urethral systems)
• Vacuum constriction devices
• Penile prosthesis

What is it?

People with advanced cancer may experience pain. It can impact you both physically and emotionally, affecting healing and contributing to fatigue, loss of appetite and difficulty sleeping. Depending on your cancer and the type of treatments your received, you may experience pain that is acute (short-term), chronic (long-term) or breakthrough (pain that occurs despite a regular dose of pain medicine).

Tips for managing it

The most important thing to know about cancer pain is that you don’t have to accept living with it. Your healthcare team has many ways to help you manage pain, and there are a few things you can do to help them:

Speak up

Nobody is expecting you to “just deal with it” and nobody will think you’re weak for admitting you’re in pain. The more your healthcare team knows, the better equipped they are to help get your pain under control.

Track your pain

Note when pain happens, what triggered it, where it is, how strong it is (try a simple scale from 1 to 10) and what you did to try and make it better. This kind of information is very helpful to your healthcare team as they try to get your pain under control.

Stick with it

It may take hours or days to get your pain under control. In the meantime, many strong pain medications can have side effects like confusion, lethargy and sleepiness. Don’t let these stop you from sticking with your pain medication regimen! After the first few doses, these side effects usually resolve and you’ll feel more like yourself again.

Work with your healthcare team

You and your healthcare team can put together a pain management plan. This may include:

• Over the counter medication
• Prescription medication
• Treatments that remove the source of the pain e.g. radiation treatments

What is it?

About 50-80% of men on hormonal therapies for prostate cancer will experience some sort of hot flashes. They usually start as a sudden feeling of warmth in the face and chest that then spreads to the rest of the body in waves, lasting anywhere from 2 to 30 minutes. You may also experience sweating, reddening of your skin, a racing heart or feelings of anxiousness. The exact cause of hot flashes is unknown, but it may be related to how hormones interact with a part of your brain called the hypothalamus, which controls body temperature.

Tips for managing them

Hot flashes usually get better as your body gets used to treatment or if medication is stopped, but there are a number of things you can do on a daily basis to help manage them:

• Dress in layers so that you can remove them when you get hot, and wear looser clothing in lighter fabrics (e.g. clothes made with cotton).
• Stick to air conditioned or cool areas with lots of air circulation (e.g. from a fan or open window).
• Avoid hot drinks, caffeine, spicy foods, tobacco and alcohol.
• Practice taking slow, deep breaths when you feel a hot flash coming on, or try relaxing activities like yoga or meditation.

What is it?

Many men who have radiation, TURP (transurethral resection of the prostate) or radical prostatectomy will experience incontinence – the involuntary leakage of urine. The good news is that it’s usually only temporary, and by 6 months after surgery most men will only lose a few drops of urine when lifting, sneezing or coughing (also called stress incontinence). Some men may also experience urge incontinence (also called overactive bladder) – a strong, sudden urge to urinate.

Tips for managing it

Incontinence can make you feel self-conscious and embarrassed, leading to a decreased enjoyment of life. If you’re older, it can also increase your risk of falling as you rush to the toilet. But there are many lifestyle changes you can make to minimize its impact on you as you heal:

• Drink less, especially before bed. Try to avoid alcohol, caffeine, carbonated and sweet drinks, and spicy and acidic foods.
• Schedule regular trips to the bathroom every few hours, and train your bladder by gradually increasing the time.
• Work out your pelvic floor muscles (which help hold in urine) with Kegel exercises. Your doctor can give you advice on how to get started.

Work with your healthcare team

In addition to lifestyle modifications, there are a few ways your healthcare team can further help you get incontinence under control:

• Medications that reduce bladder irritability, decrease bladder spasms or improve bladder emptying
• Surgical procedures to eliminate blockages in the urethra
• Implants to help close off the flow of urine

By looking after your own mental, emotional and physical well-being, you’ll be better equipped to deal with the changes that come from living with advanced cancer and its treatment. The role you play in looking after yourself is just as important as any medicine or treatment.