What Is Advanced Prostate Cancer?
Prostate cancer affects your prostate gland, a small, walnut-shaped organ that makes fluid needed for sperm. Prostate cancer is considered advanced if it’s spread beyond your prostate gland and the area around it. It can develop in people who were newly diagnosed as well as in men who were already treated for early-stage disease.
Advanced prostate cancer is also often known as stage IV (metastatic) prostate cancer. It has a lower five-year survival rate than other, less advanced stages of prostate cancer: around 34%. But it’s important to remember that other factors, like your age, overall health, PSA level, and cancer grade can impact your prognosis (outlook) too.
It can be overwhelming to live with advanced prostate cancer. But there are many things you can do to improve your quality of life.
Exercise With Advanced Prostate Cancer
If you have advanced prostate cancer, it’s important to stay active. This is especially true if you’re going through androgen deprivation therapy (ADT), which can lower your bone density.
You may worry about the risks of exercise with advanced prostate cancer. But research suggests it’s not harmful. A 2023 study published in Supportive Care Cancer followed over 60 men with prostate cancer, including 35 with advanced prostate cancer, and found that it was safe.
International exercise cancer guidelines recommend that all people living with advanced cancer aim for 150 minutes of moderate exercise a week. In general, low-impact or no-impact activities like walking or swimming are better, especially if your cancer has spread to your bones. Working with a physical therapist or rehabilitation specialist to help you develop an exercise program is a good idea.
You can also add bursts of moderate exercise into your everyday activities. Stay fit with these common tasks:
- Rake leaves
- Vacuum
- Walk your dog
- Garden
- Play ball with younger family members
- Dance to music on the radio
You can also do simple resistance training exercises at home to help increase bone strength. Try exercises that only use your body weight, like:
- Planks
- Push ups
- Chair stands
- Standing calf raises
- Squats
Limitations With Advanced Prostate Cancer
If you have advanced prostate cancer, there may be challenges that crop up along the way. Treatment side effects can mess with daily life. In addition, fatigue and constant doctor appointments may make it hard to work or socialize with family and friends. Here are some common concerns and ways to work around them.
Financial worries. The management of advanced prostate cancer is itself a full-time job. It may be hard for you to work on top of doctor appointments, support group meetings, and coping with side effects. But if you opt for part-time work or to stay home entirely, you may take a financial hit.
One option may be to take Social Security Disability Insurance (SSDI). It’s a federal benefit for people who are no longer able to work due to a disability. To be able to get this, you must have held jobs before that paid into Social Security. You can apply online or call 800-772-1213 to make an appointment.
Advanced prostate cancer is on the Social Security Administration’s list of diseases on their Compassionate Allowances list. This may speed up your review process. If you are approved, you’ll get a fixed amount from SSDI each month. It’s based on how long you worked and how much Social Security tax you’ve paid.
If you aren’t approved for SSDI, the Supplemental Security Income (SSI) program is another option. The amount of money you receive is based on your income and how many other assets you have, such as a pension.
You may also qualify for other government programs, such as low-cost housing or the supplemental nutrition assistance program (SNAP). Call 800-221-5689 to be connected to your local social service department. Another helpful option includes nonprofits like Meals on Wheels. This organization provides nutritious foods that fit your needs.
Hot flashes. If you are on androgen replacement therapy (ART) to treat your advanced prostate cancer, you may have hot flashes. Up to 80% of men on certain forms of ART experience it. Hot flashes can add frustration to your daily routine and make it harder to sleep.
If you have hot flashes, you may notice:
- A sense of warmth in your face and upper body
- Nausea
- Sweating
- Sleep disturbances
There are many treatments that can help with hot flashes. They include:
Medications. The following drugs have been shown to help relieve hot flashes in men. One option is hormonal drugs like medroxyprogesterone acetate (Provera) and cyproterone acetate (Cyprostat). One study found they were over 80% effective in reducing hot flash symptoms.
The anti-seizure drug gabapentin (FusePaq Fanatrex, Gabarone, Gralise, Neurontin) and SSRI antidepressants such as venlafaxine (Effexor XR) can also help.
Acupuncture. One small study found that 95% of men on ADT who were treated with ear acupuncture reported a significant decrease in hot flashes.
Lifestyle measures. The same things women do when they go through menopause can aid with your symptoms as well. You can:
- Lower your bedroom temperature when you sleep
- Dress in layers
- Carry a portable fan
- Avoid alcohol, spicy foods, and caffeine
- Don’t smoke
Mood Changes
Depression and anxiety are common among men with advanced prostate cancer. It’s important to talk to your doctor if you notice either. They can refer you to a mental health specialist and prescribe medication to relieve symptoms. But the following self-help strategies may make you feel better, too:
Accept your fears. If you have advanced prostate cancer, you may worry about death. That’s normal. Don’t beat yourself up for being scared. Focus on ways to feel better, whether it’s going for a walk, doing some deep breathing, or talking with your partner. You may also want to jot down your fears in a journal. It’s a good way to work through some of your anxiety.
Join a support group. Look for one that has many members with advanced prostate cancer. It’ll allow you to share your fears and feelings with others going through the same thing.
Adopt a healthy lifestyle. It won’t just keep your body in good shape, but it’ll also help your mind and mood as well. You can:
- Eat a plant-based diet
- Exercise regularly
- Limit or avoid alcohol entirely
- Get 7-9 hours of sleep a night
Sex With Advanced Prostate Cancer
If you have advanced prostate cancer, you may find it more challenging to have sex. You may have problems getting and keeping an erection. The pelvic muscles that support your bowel, bladder, and sexual organs can become damaged during treatment. You may also find it harder to get in the mood. If you are on hormone therapy, it blocks testosterone. This can make both issues worse.
The good news is that many men with advanced prostate cancer can resume sex and stay intimate with their partners. Here are some ways to better cope:
Your Overall Health With Advanced Prostate Cancer
If you have advanced prostate cancer, you are more at risk of developing other health complications. It’s very important to have regular physical exams and talk to your medical team about other conditions to be aware of. They may recommend the following:
A bone density screening. Men on ADT are at greater risk of developing osteoporosis, or low bone density. In fact, 20% of males develop a bone fracture within 5 years of starting this treatment. It’s recommended that you get a bone density scan at the start of ADT. Your doctor can talk to you about results and follow-up testing. If your bone density is low, they may recommend that you start an osteoporosis medication such as a bisphosphonate. All men on ADT should get 1,000 to 1,200 milligrams of calcium daily, and 800 to100 international units (IU) of vitamin D. You can get these nutrients from food or supplements.
A cardiologist. The most common cause of death among people with prostate cancer (other than cancer itself) is heart disease. ADT can increase that risk. It also appears to raise the risk of developing diabetes. A cardiologist can review your medical history and recommend the following:
- Cholesterol medications such as statins if you have high cholesterol
- Blood pressure medications if you have high blood pressure
- Medications such as metformin (Glucophage, Glumetza, Riomet) to lower blood sugar if your levels are elevated
If you already have heart disease, your doctor may want you to take aspirin every day. It’s also important to quit smoking if you haven’t done so.
Anemia screening. About 90% of men on ADT develop anemia. It’s a common side effect since the treatment decreases the production of red blood cells. If you do develop anemia, your doctor can give you medications or even a blood transfusion. A blood transfusion replaces blood or parts of your blood that are missing.
Plan for the Future With Advanced Prostate Cancer
An advanced prostate cancer diagnosis isn’t a death sentence. But it helps to be prepared for any next steps. It’s a good idea to do the following, especially if you’re in the hospital for a medical emergency:
Create advance care directives. These are legal documents that provide instructions for your medical care team if you can no longer communicate what you want. They include:
- A living will, which includes directions for how you want to be treated if you can’t make your own emergency decisions.
- Health care proxy, which names someone to make health care decisions for you if you become unable to. You can do this instead or in addition to a living will.
Store important papers. Place all your papers and legal documents in one area, like your desk or a safe. Some things that you may want to include are:
- Your Social Security number
- Names and addresses of your spouse and kids
- Location of your birth, marriage, divorce, or citizenship certificates
- Names and phone numbers of close friends, relatives, doctors, attorneys, and financial advisors
Stay Up-to-Date on Clinical Trials
There’s no cure for advanced prostate cancer. But newer and better treatments can offer you the latest care. Ask your doctor if there are any clinical trials near you that you may be a fit for. This means that you may be able to get a treatment before it gets FDA approval and becomes widely available. You can also find a list of open and ongoing trials at ClinicalTrials.gov.
Takeaways
Life with advanced prostate cancer can, at times, be overwhelming. It’s important to stay active. This will help keep both your body and mind healthy and reduce side effects from medications such as ADT. There are options to help you manage changes, such as taking an early retirement or managing side effects such as sexual issues. It’s important to plan for the future with advanced prostate cancer. That means getting affairs in order and looking for new treatments through clinical trials. Advanced prostate cancer isn’t a death sentence. There’s a lot you can do to continue living a full life.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
American Cancer Society: “Social Security Disability Insurance (SSDI) for Cancer Patients,” “What Are the Survival Rates for Prostate Cancer?”
Cancer Care: “Living With Metastatic Prostate Cancer.”
Fred Hutch Cancer Center: “Exercises for Prostate Cancer.”
National Institute on Aging: “Getting Your Affairs in Order Checklist,” “Hot Flashes: What Can I Do?”
Sex Medicine: “Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach.”
Social Security Administration: “SSI.”
Support Care Cancer: “ExPeCT: A Randomized Trial Examining the Impact of Exercise on Quality of Life in Men with Metastatic Prostate Cancer.”
UptoDate: Patient Education: Treatment for Advanced Prostate Cancer (Beyond the Basics), “Overview of Sexual Dysfunction in Male Cancer Survivors,” “Side Effects of Androgen Deprivation Therapy.”
World Journal of Men’s Health: “Prostate Cancer and Sexual Function.”
ZERO Prostate Cancer: “Erectile Dysfunction,” “Exercise, Physical Activity & Prostate Cancer,” “Maintaining a Healthy Lifestyle,” “Mental Health & Support Resources for Prostate Cancer.”
