This post was written by Veda Giri, M.D., Associate Professor of Medical Oncology and Cancer Biology, Director of Cancer Risk Assessment and Clinical Cancer Genetics, Co-Director of Center of Excellence for Cancer Risk, Prevention, and Control, together with members of the Center of Excellence in Cancer Risk, Prevention, and Control as well as the Prostate Cancer Treatment Team at the Sidney Kimmel Cancer Center at Jefferson.
The American Cancer Society estimates that 2.8 million men are either living with prostate cancer or have had the disease at one time. This translates to an ever growing pool of prostate cancer survivors. Patients often feel grateful for life-saving treatment and are sometimes less inclined to discuss side effects even when those symptoms impact their quality of life. Therapeutic options that include surgery, radiation therapy, hormonal therapy, chemotherapy, and newer targeted agents can nonetheless leave cancer survivors with concerns and potential side effects in the short and long term.
For example, urinary and sexual dysfunction can result from surgery, radiation, or hormonal therapies (treatments that lower testosterone levels). Bowel function can be affected by radiation therapy. Mood changes, such as depression, fatigue, and decrease in libido can also occur from some hormonal therapies. Longer term use of hormonal therapy can lead to increased risk for cardiovascular disease, osteoporosis, and decreased cognitive function. Finally, men may also have concerns about cancer risk for their children and other family members after going through their own cancer treatment.
While many survivors learn to deal with these issues, it’s just as important that men discuss these issues with doctors during treatment and follow up visits. Most cancer centers are now phasing in survivor care plans to ensure that side effects that persist even after the end of treatment are addressed by the cancer care team. Survivor care plans can provide a roadmap and resources for the survivor to maintain optimal health and well-being and can help address a wide range of issues.
Many post-treatment side effects will improve within 6-12 months. However, if symptoms last longer and become chronic issues, we have approaches that may help. Low sexual function can be managed with medications used for erectile dysfunction after consideration of potential side-effects. If symptoms of depression persist, speaking to a health professional trained in psychological aspects of survivorship can help. These experts are trained in finding appropriate management options such as behavior modification or anti-depressants as needed. There may be a role for bone density measurements to assess for the development of osteoporosis for men on longer-term hormonal therapy.
Few patients realize that prostate cancer can be passed down through the family similar to breast cancer. Men who have undergone treatment may want to consider genetic evaluation for inherited cancer risk. Cancer risk assessment and genetic counseling can provide men with information regarding their own prostate cancer development in light of family cancer history to make an informed decision regarding options for genetic testing and learn about potential cancer risks for men and women in their family.
A good survivorship plan should always include suggestions for healthy living. Maintaining and improving your health and diet habits after prostate cancer treatment can help reduce cardiovascular risks, improve bone health, and have positive impact on mood. Regular exercise and following a balanced diet that includes a wide range of fruits and vegetables, lean meats or proteins, and low saturated fat and cholesterol is beneficial for overall health and can limit some of the longer-term effects of prostate cancer treatment.
This Prostate Cancer Awareness Month, let’s pay special attention to the needs of the millions of prostate cancer survivors to improve their quality of life towards a meaningful return to daily living.