You’ve made it through prostate cancer treatment successfully, and your doctor has pronounced you cancer-free. You are probably feeling an overwhelming sense of relief! The last thing you ever want to think about is that the cancer may come back. It is up to you now to make sure it doesn’t by visiting your doctor regularly and committing to a healthy lifestyle.
Awareness of your personal health has probably never been this high – you have had to endure uncomfortable tests, even more uncomfortable treatments, and maybe even some undesirable side effects. Because you have successfully navigated through all of these experiences, you can now help other men and their families to understand the disease, how it is treated, and what they can expect physically and emotionally, as well as provide them with a source of support and inspiration. Becoming an advocate for prostate cancer patients and their families can not only help other men and their families, but can improve your own emotional recovery from the disease.
This section gives a brief summary of what you need to do for the long-term to keep the chance of cancer recurrence low. It also describes ways in which you can become an advocate for prostate cancer awareness.
For information on side effects related to erectile dysfunction, sex and intimacy, visit www.ustoo.org/intimacy.
For information on side effects related to incontinence, visit www.ustoo.org/incontinence.
As prostate cancer advances, your bones can be impacted. Bone health may be affected by prostate cancer and its treatment.
- Treatment-induced bone loss – often occurs with androgen deprivation therapy due to the reduced level of testosterone; it occurs following bilateral orchiectomy or when an LHRH agonist or antagonist is administered. (The list includes Lupron® or Eligard (leuprolide acetate), Zoladex® (goserelin acetate implant), Trelstar (triptorelin pamoate), Vantas LR (histrelin acetate)
- Bone metastases – A result of advancing prostate cancer, when the disease spreads to the bones
- Radiation therapy to the bone and some kinds of chemotherapy also might decrease bone density and increase the risk for bone loss
Bone Metastases and Advancing Prostate Cancer
Another situation in which bone is affected by prostate cancer is when the cancer metastasizes, or breaks away and travels—usually via the bloodstream—to other parts of the body, primarily in the advanced stages of the disease. When this happens in prostate cancer, the most common place for the cancer to go is to the bone. The bones most commonly affected are the spine, hips, and ribs. Normal bone is constantly being remodeled, or broken down and rebuilt. Cancer cells that have spread to the bone disrupt the balance between the activity of osteoclasts (cells that break down bone) and osteoblasts (cells that build bone), disrupting their normal remodeling and causing excessive bone breakdown or abnormal build-up. Bone metastases cause damage that may make the bone more susceptible to complications such as pain and fractures.
Prostate cancer behaves differently in each individual. In many men, prostate cancer never spreads to any other site. In the men in whom it does spread, bone metastases occur in 65% to 75% of all patients, and the bone is often the only site of metastases.
Prostate cancer that spreads to the bones is still prostate cancer, not bone cancer. Bone metastases result in areas of weak, unstable bone that could cause debilitating pain and fractures.
Spinal or Vertebral Compression Fractures
Although the majority of spinal fractures (also called vertebral compression fractures or VCFs) are caused by osteoporosis, cancer and medical treatments such as hormone therapy and chemotherapy can also weaken bone and increase the likelihood of fracture.
About 1 million American men are now receiving androgen deprivation therapy (ADT), also known as hormone therapy, annually — 19% are at an elevated risk of developing vertebral compression fractures (VCFs). Men on androgen deprivation therapy should have their bone density measured and treatment should be administered when it is low. FDA approved medications are available.
Treating Pain Associated With Advanced Prostate Cancer
When prostate cancer has spread to other tissues in the body, particularly the bones, it can cause pain. Radium-223 (Xofigo) has recently been approved, which treats this pain and prolongs survival. External beam radiation or systemic radiation therapy such as samarian-153 (Quadramet®) and strontium-89 (Metastron®) can reduce bone pain caused by metastases. Bisphosphonate medications, usually pamidronate (Aredia®) and zoledronic acid (Zometa®), can reduce skeletal related events that include pain, fracture and the need for radiation or surgery.
Xgeva™ (denosumab) is indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors. Xgeva is a fully human monoclonal antibody that binds to RANK Ligand, a protein essential for the formation, function and survival of osteoclasts (the cells that break down bone). Xgeva prevents RANK Ligand from activating its receptor, RANK on the surface of osteoclasts, thereby decreasing bone destruction.
Prostate Cancer and Bone Health: The Bottom Line
An independent, successful, satisfying life is possible with prostate cancer. Because prostate cancer has an affinity for your bones, knowing about your bones is important. You can make a difference in managing your bone health:
- Don’t let symptoms scare you. See them as a signal to get more information and take action.
- Not all symptoms represent recurrence of prostate cancer.
- Maintaining your bone health will help maintain your quality of life.
- If you have symptoms that concern you, quickly tell your health care provider.
- The sooner your symptoms are diagnosed, the more that can be done to help.
- You are the expert on you. Know yourself…and trust yourself.
Long-Term Care Issues
If you’ve been treated for prostate cancer and have been declared cancer-free by your doctor, chances are you’re biggest worry is that the cancer may come back. Sticking to your follow-up appointment schedule and living healthy can keep your risk of recurrence low.
Your doctor will schedule routine follow-up examinations, usually every 6 months for 5 years, and then yearly. He will test your serum PSA level at regular intervals, usually every 3 to 6 months for 1 to 2 years and then annually. Your doctor may also perform yearly DRE's. A repeat prostate biopsy may be performed in men on active surveillance or those treated with radiation therapy, cryosurgery, or HIFU if the PSA increases.
It’s important for you to realize that PSA levels normally fluctuate, and that if your PSA levels begin to rise a few years after radiation treatment, it may not mean that the cancer has returned. Make sure that you commit to taking a PSA test as recommended by your doctor and talk candidly with your doctor about any concerns you may have.
Although the causes of prostate cancer aren’t fully understood, eating well, getting plenty of rest, and exercising regularly may reduce your risk of cancer recurrence.
Testosterone stimulates prostate cell growth, and what you eat can change your testosterone levels.
- Limit intake of high-fat foods, which can stimulate testosterone
- Increase intake of soy products that contain isoflavones, which may reduce testosterone, although its effect in men with prostate cancer is not well studied
Many foods contain antioxidants, substances that can prevent cell damage and may enhance the immune system and reduce the risk of cancer and infection. A low-fat diet of fish, fruits, vegetables, and grains contain antioxidants and may decrease the risk of cancer.
|Vitamin A and Carotenoids||Vitamin C||Vitamin E||Selenium||Lycopenes|
|Carrots||Citrus fruits||Nuts and seeds||Whole grains||Tomatoes|
|Squash||Green peppers||Whole grains||Garlic||Tomato products|
|Sweet potatoes||Green leafy vegetables|
Regular exercise has been shown to strengthen the immune system and improve digestion, circulation, and the removal of waste products from the body. In men with prostate cancer, exercise can help reduce osteoporosis and the weight gain associated with androgen deprivation therapy. Exercise also prevents obesity, which is a risk factor for many diseases, including cancer. Regular exercise may also reduce the risk of benign prostatic hyperplasia (BPH), or prostate gland enlargement.