Controlling symptoms of advanced (metastatic) prostate cancer 1 Controlling symptoms of advanced (metastatic) prostate cancer This information is from the booklet Understanding advanced (metastatic) prostate cancer. You may find the full booklet helpful. We can send you a free copy see page 7. Contents Controlling symptoms Pain Malignant spinal cord compression Tiredness Constipation Difficulty sleeping (insomnia) High levels of calcium in the blood (hypercalcaemia) Weakened bones Complementary therapies More information and support Controlling symptoms Advanced prostate cancer may cause unpleasant symptoms. These may be relieved by treating the cancer itself. Sometimes, treatments work quickly and you may notice an improvement within a few days. Other treatments may take longer to work, so it can take a couple of weeks before you begin to feel any benefit. Apart from treating the cancer itself, there are many other ways to help relieve symptoms. In this section we ve listed some symptoms and side effects, including some tips to help you cope with them.
Controlling symptoms of advanced (metastatic) prostate cancer 2 Pain There are many different types of painkillers. They vary both in their strength and in the way they work. Some painkillers are better for certain types of pain, and some suit certain men better than others. It s often better to take painkillers regularly, even if you re not in pain when the next dose is due. This is because painkillers not only relieve pain at the time, but prevent it from coming back too. Painkillers can be taken as tablets, liquids, or as suppositories that are inserted into the back passage (rectum). Some are also given as injections under the skin, or patches that are applied to the skin. It s important to tell your doctor or nurse if the painkillers you re taking aren t easing your pain. Your doctor can either change the dose, or change the painkillers to something else that will be more effective for you. Treating bone pain Pain caused by prostate cancer cells in a bone can be severe. Radiotherapy can be given to relieve pain. Treatment is given to the affected bone or area. It may be given as a single treatment, or may be divided into a series of smaller treatments. Radiotherapy is very good at easing bone pain, but can take a few weeks to work. Often, drugs containing morphine are also needed. They can be very helpful at reducing pain while the treatment is being planned, or while you are waiting for the radiotherapy to work. Some men find that morphine makes them feel drowsy when they first start taking it, but this usually only lasts for a day or so. Taking morphine may also make some men feel sick at first, and they may need to take an anti-sickness (anti-emetic) tablet prescribed by their doctor for the first few doses. It may also cause constipation. Non-steroidal drugs If pain is due to prostate cancer cells in a bone, non-steroidal anti-inflammatory drugs (NSAIDs) can help. These have few side effects, but can sometimes irritate the lining of the stomach. NSAIDs aren t suitable for all men. Your doctor can give you more information about them. Bisphosphonates These can also help relieve bone pain. Bisphosphonates such as zoledronic Acid (Zometa ) may help to strengthen bones and lower the risk of fractures. They can also reduce high levels of calcium in the blood (hypercalcaemia), as well as reduce pain. They may be given into a vein (intravenously) in the outpatients department every 3 4 weeks. Other ways of treating pain Denosumab (Xgeva, Prolia ) is a newer drug that helps to protect the bones. It is a type of treatment called a targeted therapy. It may not be widely available your doctor can give you more information about this.
Controlling symptoms of advanced (metastatic) prostate cancer 3 We have more information about bisphosphonates, steroids and denosumab that we can send you. Heat can also help to ease pain. A long soak in a warm bath, a heat pack, or a well-protected hot water bottle can all bring some short-term pain relief for some men. If you re having trouble sleeping because of pain, your doctor can prescribe sleeping tablets or a mild relaxant. If you are anxious and having difficulty sleeping, your pain may be worse. You may find that practising relaxation techniques can help you feel more comfortable. A gentle massage can also help your body relax and distract your mind from pain. It s advisable to have a massage from a trained massage therapist who works with cancer patients. Being in pain can make you feel very low. Let your doctor know if the drugs prescribed aren t working. Remember there are many different ways to control pain. There are special NHS pain clinics run by doctors and nurses who are experts in treating pain. You can ask your doctor to refer you to a clinic if your pain is not controlled by any of the methods mentioned here. We can send you our booklet, Controlling cancer pain, which has more detailed information. We also have a booklet called Controlling the symptoms of cancer, which you may find helpful. Call 0808 808 00 00 to order these. Malignant spinal cord compression Malignant spinal cord compression (MSCC) happens when cancer cells grow in, or near to, the spine and press on the spinal cord and nerves. The symptoms of spinal cord compression are caused by the increasing pressure (compression) on the spinal cord and nerves. Symptoms of MSCC include: back or neck pain numbness or pins and needles in your toes, fingers or buttocks feeling unsteady on your feet bladder or bowel problems. If you notice any of these symptoms, let your doctor know immediately so they can do some tests. Your doctor will usually advise you to lie flat on your back until results are ready. The earlier MSCC is diagnosed, the better the chances are of treatment being effective. Steroids, radiotherapy and surgery may all be used, depending on your particular situation. Your doctor will discuss any risks with you first.
Controlling symptoms of advanced (metastatic) prostate cancer 4 We have more information about malignant spinal cord compression that we can send you. Tiredness You may find that you easily become tired and that your body is no longer as strong and reliable as it once was. This may be because of the cancer or the side effects of treatment. It can take time to adjust if tiredness makes it difficult for you to drive or take part in your usual activities, or if you have to walk more slowly than before. You may need to rest more, and you may be unable to do the things you once took for granted. If you have little energy, save it for the things you really want to do. Often, reorganising your daily activities can be helpful. Using a walking stick, frame or wheelchair can improve your quality of life, allowing you to move around more easily. Sometimes, the cancer or its treatment can cause anaemia, which can make you feel tired. If this happens, you may be given a blood transfusion, which can often give you more energy and reduce tiredness. You may find it helpful to read our booklet, Coping with fatigue. Constipation Constipation can be caused by taking strong painkillers, or if you have too much calcium in your blood. It can also occur if you lose your appetite and are not eating as much as before, or if you are getting less exercise. Having fibre in your diet, drinking plenty of fluids and walking will help, but you may also need to take a medicine (laxative) to stimulate the bowels. Your doctor will be able to prescribe one that s suitable for you. Your nurses can also advise you on ways to prevent or relieve constipation.
Controlling symptoms of advanced (metastatic) prostate cancer 5 Difficulty sleeping (insomnia) Even though you may feel tired, it s not uncommon to have difficulty sleeping. You may have a lot on your mind, and this can add to the problem. Sleeping tablets can be helpful, and the newer types are less likely to make you feel drowsy the following day. You can also try some of these remedies malted milk drinks before bed, a glass of brandy or whisky in the evening, warm baths with soothing bath oils, or a relaxing body massage to relieve muscle tension. We can send you information about difficulty sleeping. High levels of calcium in the blood (hypercalcaemia) Prostate cancer cells in a bone may cause extra calcium to be released into the blood. High calcium levels can make you feel extremely tired and thirsty, and you may pass lots of urine. Hypercalcaemia can also make you feel sick, and some people become irritable and confused. Depending on your calcium level, you may be able to have treatment as an outpatient, or you may need to spend a few days in hospital. Your doctor will give you drugs called bisphosphonates. These are given as a drip. Each treatment takes between 15 minutes and one hour, and can be repeated every few weeks. They are usually good at getting the calcium levels back to normal. Your doctor may also ask you to start drinking plenty of water. Sometimes, a drip may be needed to give extra fluids into a vein in your arm (an intravenous infusion).
Controlling symptoms of advanced (metastatic) prostate cancer 6 Weakened bones Prostate cancer cells in a bone can weaken it. Your doctors may suggest you have bisphosphonates or treatment with denosumab to help strengthen the bone and prevent it from breaking. You may need an operation if prostate cancer cells have weakened a bone so much that there s a risk of it breaking. This is done under a general anaesthetic. The surgeon will put a metal pin into the centre of the bone and may also fix a metal plate to it. This holds the bone firmly so it won t break. The pin and plate can stay in permanently. This is mainly used for the long bones in the legs, but is sometimes used when there are secondary cancers in other bones such as the spine. If your hip is affected, the hip joint may be replaced. You ll need to stay in hospital for a week or longer after the operation so you can fully recover. However, most men are able to get up and start walking around a couple of days after surgery. This sort of operation may be done before radiotherapy, if there is a chance the bone may break before the radiotherapy has had a chance to work. Complementary therapies Some men find that complementary therapies can help them feel stronger and more confident in dealing with advanced prostate cancer. It s important to tell your doctors if you re planning on using any complementary therapies. They can usually be used alongside conventional treatments and medicines. Complementary therapies can help to improve quality of life, and can sometimes help to reduce symptoms. Some complementary therapies, such as meditation or visualisation, can be done by the person with cancer themselves. Other therapies, such as a gentle massage, can be carried out by a trained massage therapist, and relatives and carers can be shown how to do it for you at home. Many hospices and hospitals offer complementary therapies alongside conventional care. These may include: aromatherapy colour and sound therapy massage relaxation, visualisation or guided-imagery techniques acupuncture. We can send you our booklet about cancer and complementary therapies.
Controlling symptoms of advanced (metastatic) prostate cancer 7 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. Visit macmillan.org.uk or call us on 0808 808 00 00, Monday to Friday, 9am to 8pm. You can order a copy of Understanding advanced (metastatic) prostate cancer or any other cancer information, from be.macmillan.org.uk or by calling us. Hard of hearing? Use textphone 0808 808 0121, or Text Relay. Speak another language? We have telephone interpreters. We provide information in a range of languages and formats. Visit macmillan.org.uk/otherformats or call us. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Macmillan Cancer Support 2015. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Revised in October, 2015. Next planned review in 2018.