After Prostate Cancer Treatment Ends

By Rebecca Cowens-Alvarado, MPH

According to the American Cancer Society, there are nearly 3 million prostate cancer survivors in the United States today and this number is expected to increase to almost 4.2 million by 2024.  Most prostate cancers (93%) are diagnosed at the local or regional stage, before the cancer has spread to surrounding organs. Treatment at these early stages is often very successful, and the 5-year relative survival rate approaches 100%.

Treatments for prostate cancer patients vary based on age and stage of diagnosis, but the majority of prostate cancer patients younger than aged 65 are more likely to be treated with radiation, radical prostatectomy, or a combination of both. Some patients may also be treated with androgen deprivation therapy (ADT), while others may simply undergo active surveillance, or “watchful waiting,” to see how the prostate cancer progresses before choosing a treatment option. While the survival rate for prostate cancer is high, being diagnosed and treated for prostate cancer may cause a number of physical, psychological, and social side effects that can last (or develop) long after treatment ends.

Common issues faced by prostate cancer survivors who underwent surgery or radiation include: difficulty having an erection and decreased interest in sex, which may impact sexual intimacy; needing to urinate quickly or not being able to control when they urinate; bowel problems such as not being able to control or having diarrhea; and distress or depression. Prostate cancer survivors who are on ADT may also experience lack of interest in sex, hot flushes, weakening of the bones (osteoporosis) and increased risk of heart attack or diabetes. And for those undergoing active surveillance or watchful waiting, the anxiety and distress from waiting for the results of frequent prostate-specific antigen (PSA) tests are very real. [more]

American Cancer Society guidelines for prostate cancer survivorship

The cancer care team is equipped to deal with these side effects when they occur during cancer treatment. But in order for prostate cancer survivors to achieve the best possible health and quality of life, side effects also need to be addressed after treatment ends, when the patient is back to visiting his primary care clinician.  In order to help improve follow-up care of prostate cancer survivors by primary care clinicians, the American Cancer Society recently developed clinical follow-up care guidelines for prostate cancer survivors. These guidelines address:

  • Healthy eating
  • Physical activity
  • Quitting and avoiding tobacco
  • Limiting alcohol consumption
  • Receiving information about screening for second primary cancers
  • Evaluating and managing physical, emotional, and psychosocial long-term and late effects
  • Coordinating care between primary care clinicians and the cancer care team
  • Making sure the patient is under surveillance for cancer recurrence

We hope that these recommendations allow prostate cancer survivors and the primary care clinicians charged with their care to be more aware of what’s needed for their long-term health.

Healthy eating, exercise, limiting alcohol, avoiding tobacco

Healthy diet and regular exercise are important to prostate cancer survivors for a number of reasons. Research has linked obesity to poorer survival and increased risk of the PSA test numbers going up again for prostate cancer survivors. Eating well and getting regular physical activity can help with weight control.

These habits can also help survivors deal with other common side effects like decreased sex drive, bowel issues like diarrhea that affect how much nutrition a body can take in, emotional distress or depression, and increased risk of diabetes and heart attack. Eating a diet low in saturated fat and rich in fruits, vegetables, and whole-grains, and limiting alcohol intake to no more than 2 drinks per day has been shown to improve the health and quality of life of prostate cancer survivors. Getting at least 150 minutes of physical activity each week through aerobic activities and strength training has also been shown to reduce fatigue and improve mood and sex drive, as well as reduce the risk of bone fracture.  

There is no safe way to use tobacco. Smoking increases the risk of prostate cancer recurrence, not to mention getting a new cancer. Avoiding it is an important step for your health, both short-term and long-term. After all, in the United States, tobacco use is responsible for nearly 1 in 5 deaths – about 480,000 early deaths each year. 

Watching for recurrence and other cancers

After prostate cancer treatment ends, survivors should watch for signs of other cancers. The risk of bladder and rectal cancer is slightly increased in men treated with radiation therapy. So, survivors should report to their clinicians any blood in their urine or stool (feces), which could be signs of bladder or rectal cancers. For prostate cancer recurrence, the National Comprehensive Cancer Network (NCCN) surveillance guidelines should be followed using a PSA test, with or without digital rectal examination (DRE), as indicated by your health care team. And all survivors should continue to follow American Cancer Society cancer screening guidelines for other cancers.

Managing long-term (late) effects, coordinating care

Regular communication between the primary care clinician, members of the oncology team, urologists and other specialists, and prostate cancer survivors and their caregivers will help ensure that prostate cancer survivors have access to the resources that will help them stay healthy and achieve a high quality of life after cancer treatment ends.

A survivorship care plan can help with this.  These plans provide detailed information about treatment and needed follow-up care. Patients may be able to get one from their oncology team, or build their own with their primary care clinician or oncology team.

Joining an online community, such as the American Cancer Society Cancer Survivors Network or WhatNext, developed in part with the American Cancer Society, may be a source of information, support, and inspiration for prostate cancer survivors. For survivors who want to take a more active role in managing their life after treatment, participating in a self-management workshop (such as the National Council on Aging’s “Better Choices, Better Health” online and community-based program) may help them set and achieve goals to be healthier.

 

Cowens-Alvarado is the director of cancer control mission strategy for the American Cancer Society and the principal investigator for the National Cancer Survivorship Resource Center, a collaboration between the American Cancer Society and the George Washington University Cancer Institute funded through a 5-year cooperative agreement with the Centers for Disease Control and Prevention.

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