What is fatigue?

Fatigue is a feeling of extreme tiredness that doesn’t go away, even after you rest.

Fatigue is different from normal tiredness. Normal tiredness might affect you if you’ve worked hard, exercised, or if you haven’t had enough sleep. Unlike fatigue, normal tiredness usually gets better once you’ve rested.

Fatigue is very common in men with prostate cancer. Around three in four men with prostate cancer (74 per cent) will have fatigue at some point. There are things you can do to help manage your fatigue and give you more energy. And there’s a lot of support available.

Watch our video to learn more about fatigue:

How might fatigue make me feel?

You might use some of these words to describe how fatigue makes you feel: tired, exhausted, weak, lethargic, drained, knackered, shattered, whacked, beat, spent, weary, drowsy, weighed down, done in

Fatigue can make it hard to carry out your daily activities. It can make it difficult to do some things, such as:

  • everyday tasks, such as getting dressed, having a shower or preparing food
  • social activities, such as seeing friends and family
  • sleeping (insomnia)
  • concentrating
  • remembering things
  • understanding new information and making decisions.

Some men find that they suddenly feel very tired. This means you need to be careful in certain situations – for example, when you are driving.

Fatigue can affect your mood. It might make you feel sad, depressed, or anxious. And you may feel guilty that you can’t do the things you normally do.

It can also have an impact on your relationships. You may start to depend more on others. You might not feel able to go to work or see your friends and family as much as usual. This can make you feel lonely or isolated. Fatigue can also affect your sex life, as you may not have enough energy for sex.

Many men are surprised by how tired they feel and by the impact it has on their lives. Some men tell us that fatigue is one of the hardest parts of having prostate cancer. It can be very frustrating, especially if you are used to being active.

Every man’s experience is different. You might have some or all of these effects of fatigue. And your feelings might change over time.

Understanding new information

Because fatigue can affect your concentration, you might find it hard to understand new information about your prostate cancer. You might feel stressed about having to make decisions about your treatment. Talk to your doctor or nurse and take your time to make sure you have all the information you need before making any big decisions.

Fatigue hits you at random times. You feel okay and then all of a sudden you have a bad day. I found it difficult to adjust to.

- A personal experience

 

Why might I get fatigue?

We don’t know exactly why men with prostate cancer commonly get fatigue. It’s likely that lots of different things are involved, including the following.

Prostate cancer itself

Cancer can stop the normal cells in your body from working properly. This can change the way your body uses energy and can cause fatigue.

Treatments for prostate cancer

All treatments for prostate cancer can cause fatigue. Your fatigue is likely to be worse if you have hormone therapy, radiotherapy or chemotherapy, or more than one treatment at the same time.

Stress, anxiety or depression

Feeling stressed or worried can cause fatigue. You might be worried about being diagnosed with cancer or about having treatment. Depression can also cause fatigue.

Travelling to appointments

Travelling to the hospital or GP surgery for treatments and check-ups can make your fatigue worse.

Symptoms of advanced prostate cancer

Some problems that can be caused by advanced prostate cancer, such as pain or anaemia, can cause fatigue.

Pain or pain-relieving drugs

You might have pain caused by your prostate cancer or by another health problem. Pain can make your fatigue worse. Some pain-relieving drugs can also cause fatigue(. Speak to your doctor to make sure you’re on the best pain-relieving drugs for you.

Other health problems

Some other health problems, such as kidney disease or arthritis, can cause fatigue.

Not sleeping well

Not sleeping well at night can make your fatigue worse. And having fatigue can make it harder to sleep well. You might have worries that keep you awake at night. Or you might wake up in the night because of symptoms of prostate cancer or side effects from your treatment, such as having a hot flush or needing to urinate.

Lack of physical activity

Being inactive can make your fatigue worse. It can also make it harder to sleep properly at night. You might not have a lot of energy so it can be difficult to be more active. But taking up regular physical activity during your treatment can improve your fatigue.

Other things that use up energy

Other things may also use up your energy and make your fatigue worse – things like going to work, caring for other people, or meeting up with friends or family. It’s important to think about things like this, to see what could be making your fatigue worse.

How long will my fatigue last?

How long fatigue lasts will vary from man to man. It may get better or worse over time. How long the fatigue lasts will depend on what’s causing it.

If your fatigue is caused by your treatment, it may improve when you finish treatment. But some men have fatigue that lasts for many months, or sometimes years. If you have life-long treatment for prostate cancer, this can cause long-term fatigue. Keeping active during treatment might help your fatigue to improve more quickly.

How long the fatigue lasts will also depend on the type of treatment you’ve had.

Surgery (radical prostatectomy)

Some men who have surgery get fatigue for a few weeks afterwards, but it can last for longer.

Radiotherapy

If you’re having radiotherapy to treat your cancer, you may have external beam radiotherapy, or a type of internal radiotherapy called brachytherapy. Both types of radiotherapy can cause similar levels of fatigue. Men on radiotherapy often find that their fatigue gets worse over time, and sometimes doesn’t start until after their radiotherapy has finished. Some men find that their fatigue improves when their treatment finishes, but for others, it can last for several months.

If your cancer has spread from your prostate to other parts of your body (advanced prostate cancer), you may be offered a short course of radiotherapy for advanced prostate cancer to treat symptoms such as pain. Your fatigue may be worse for a week or two after your treatment finishes.

High-intensity focused ultrasound (HIFU) and cryotherapy

HIFU and cryotherapy treatments can both cause fatigue but we don’t know how long the fatigue might last for. This is because they are newer and less common than some of the other treatments for prostate cancer.

Hormone therapy

Some men on hormone therapy find that their fatigue gets better over time while they’re having hormone therapy. Others find it gets worse over time.

If you’re only on hormone therapy for a few months, your fatigue may improve after you stop treatment.

If you’re on long-term hormone therapy and are finding your fatigue difficult to deal with, you may be able to have a break from treatment if tests suggest the cancer isn’t growing. This is called intermittent hormone therapy. Taking a break from treatment may mean that your fatigue improves. But it can take several months before you may notice an improvement.

Chemotherapy

Each course of chemotherapy is given as a number of sessions, each three weeks apart.

During a course of chemotherapy, your energy levels may go up and down. Fatigue is usually worse during the week after each treatment session but then gradually improves. Fatigue usually gets worse as you have more sessions of chemotherapy.

After finishing a course of chemotherapy, most men find their energy levels improve. But for some, fatigue can be long-lasting.

How can I manage fatigue?

Lots of things can cause fatigue, so there’s no one treatment that can get rid of it completely. But there are lots of things you can do to improve or manage your fatigue. Small changes to your life can make a big difference.

Talk to your doctor or nurse

Let your doctor know if you have fatigue. They can help you understand what might be making your fatigue worse and help you find ways to manage your fatigue. They can also check for any other health problems that might be causing your fatigue or making it worse.

Keep active

Physical activity can help to improve fatigue. Read more about physical activity to improve fatigue.

Plan ahead and take things slowly

You might not have enough energy to do everything you used to do. But if you plan ahead, you can try to do the things that are most important to you.

Keeping a diary can help you plan your activities. Download our fatigue diary.

The five Ps

Some men find thinking about ‘the five Ps’ helpful when planning their time.

  • Plan. Write a list of all the things you have to do.
  • Prioritise. Work out what’s most important to you each day and put that at the top of your list.
  • Pace. Allow extra time to get things done. Stop before you get too tired.
  • Permission. Give yourself permission to do things differently and take things easy for a while.
  • Position. Make the task easier. Could you sit down instead of stand?

Get help with emotional problems

Fatigue can sometimes be linked to feeling depressed or anxious. Feeling down can make you feel less energetic, and worrying all the time can affect your sleep and make your fatigue worse. If you’re having any of these feelings, talking to someone or getting some support can help. Read more about emotional impact of prostate cancer and what can help.

Ask for help

It can be difficult to ask for help when you’re used to being independent. But partners, family members and friends will usually want to help.. Think about which activities you want to do for yourself, and which ones someone else could do for you.

Make time to relax

Taking time to relax is really important. It can help with the stress of having cancer treatment and with fatigue. Try to find time to relax every day, for example by meditating, doing breathing exercises, or listening to music or an audiobook.

Eat and drink well

Eating a healthy diet can boost your energy levels. If you have problems with your diet, ask your doctor to refer you to a dietitian. Read more about healthy eating.

If you don’t have the energy to prepare food for yourself, you could ask a friend or family member to help. Or you can order healthy, cooked meals to be delivered to your home, from your local authority or a private company. Find out more about getting meals delivered.

Drinking plenty of fluids can improve your energy levels. Try to drink around 1.5 to 2 litres (3 to 4 pints) of water a day. If you often need to urinate at night, you may worry about drinking a lot. But drinking plenty of water can help to prevent bladder irritation – this means you may not need to urinate so often and may sleep better at night. However, it might help to drink less in the two hours before you go to bed. And try to avoid fizzy drinks, alcohol, and drinks that contain caffeine (tea, coffee and cola), as these can irritate your bladder and make you urinate more often.

Sort out your sleep

Although fatigue doesn’t always improve when you rest, sleeping well can help to improve your fatigue. The following tips may help you get a proper rest at night.

During the day

  • Do some physical activity. Regular physical activity can help you sleep better.
  • Try to stick to a routine so your body gets used to going to bed and getting up at the same time every day.
  • Avoid sleeping during the day if you can. If you’re feeling very tired during the day, try resting or doing a relaxing activity, rather than sleeping.

Before you go to sleep

  • Feeling hungry can disturb your sleep. Have a bedtime snack, like a banana.
  • Try to cut down on all drinks in the evening, even water, so you don’t have to get up to urinate so often. Make sure you still drink plenty of water during the day.
  • Avoid food and drinks that contain caffeine or sugar as they will keep you awake. This includes tea, coffee, and cola.
  • Avoid drinks that might irritate your bladder and make you get up more in the night to urinate. This includes fizzy drinks, alcohol and drinks that contain caffeine.
  • Don’t watch TV or use electronic devices such as a computer, tablet computer or mobile phone for at least 30 minutes before you go to bed.
  • Keep a worry book. If you can’t get to sleep because you’re worrying about something, write it down. Look at your worries during the day and ask your family, friends and medical team if they can help you sort them out.

Prepare your bedroom

  • Make sure there isn’t too much light in your bedroom. An eye mask and dark blinds or curtains might help.
  • Make your bedroom as quiet as possible. You could try using ear plugs.
  • Make your bedroom a comfortable temperature. This can be particularly important if you have hot flushes that wake you up at night.

If you’re still having trouble sleeping, speak to your GP or call our Specialist Nurses. Your GP may sometimes prescribe a course of sleeping pills to help you get some rest.

Complementary therapies

Complementary therapies may be used alongside medical treatment. Small studies have found that yoga, acupuncture, meditation and massage can improve fatigue in people who have cancer.

Some complementary therapies may have side effects or may interfere with your cancer treatment. So make sure your doctor or nurse knows about any complementary therapies you’re using or thinking of trying. And make sure that any complementary therapist you see knows about your cancer and treatments.

Some complementary therapies are available through hospices, GPs and hospitals. But if you want to find a therapist yourself, make sure they are properly qualified and belong to a professional body. You can get advice on finding a properly qualified therapist from the Complementary and Natural Healthcare Council.

For more information about different complementary therapies and important safety issues to think about when choosing a therapy, visit Macmillan Cancer Support and Cancer Research UK.

  • Getting meals delivered  

    If you don’t have the energy to prepare food for yourself, you can order healthy, cooked meals to be delivered to your home, from your local authority or a private company.

    In England and Wales

    GOV.UK provides information on local organisations that can deliver pre-prepared meals to your home.

    In Northern Ireland

    NI Direct provides information on local organisations that can deliver pre-prepared meals to your home.

    In Scotland

    Care Information Scotland provides information on local organisations that can deliver pre-prepared meals to your home.

Physical activity

Physical activity can help to improve fatigue. It can improve your:

  • energy levels
  • sleep
  • appetite
  • general health
  • mood
  • strength
  • weight.

How to get started with physical activity

Lots of people find it hard to be more active. You might be worried that you’re not fit enough to take part in an exercise class. Or you might feel frustrated that you’re not as fit as you used to be. Some treatments for prostate cancer can cause urinary incontinence, so some men worry about leaking urine when they exercise. You might also be worried about hurting yourself. If you’re worried about any of these things, speak to your doctor, nurse or physiotherapist. They can give you advice on the best type of activity for you.

Remember, any activity is better than none. Start doing what you can and build up slowly. There is lots of support and information available to help you get started, including the ideas below. You can also speak to your doctor, nurse or physiotherapist.

Light to moderate exercise can make you feel more awake. You could try:

  • standing up and sitting down
  • walking to the shops
  • climbing stairs
  • cycling
  • fixing things around the house
  • mowing the lawn
  • vacuuming
  • washing the car
  • swimming.

If you do light to moderate exercise along with strength or resistance training, such as lifting light weights or using elastic resistance bands, this may be even more effective.

You can even exercise from your chair or bed. Try lifting your arms and legs or bending and straightening them. This can help improve your movement and muscle strength.

If you’re on hormone therapy or have cancer that has spread to the bones, you may be at risk of weak bones. This can increase your risk of broken bones (fractures). It’s important to speak to your doctor, nurse or physiotherapist before you start a new activity or increase the amount of physical activity you do. They can talk to you about exercising safely and explain the types of exercise that are suitable for you.

Exercise referral schemes

Ask your doctor or nurse if there is an exercise referral scheme in your area. These are special exercise programmes for people with health problems, including prostate cancer and fatigue. They are run by healthcare professionals or fitness trainers who have experience of working with people who have health problems.

Research shows that doing exercises such as swimming or fast walking at least twice a week for 12 weeks can help men on hormone therapy to reduce their fatigue.

I found exercise the best thing to combat fatigue. It keeps your energy levels up and your stress levels down.

- A personal experience
  • Walking  

    Walking can reduce fatigue in men with prostate cancer.

    Regular physical activity, like walking, is also important for general health and can help you stay a healthy weight.

    Finding a walk

    The following organisations can help you find walks in your local area.

    Finding a walking group

    Joining a walking group can be an enjoyable, sociable way to start doing some gentle physical activity. The following organisations can help you find walking groups near you.

    • Walking for health can help you find local walking groups in England.
    • Let’s Walk Cymru is a walking programme for people in Wales who want to improve their health and well-being. They have weekly walking groups in towns, cities and villages across Wales.
    • The Ramblers have group walks as well as walking maps and routes across the UK. You can try out the walks for free and buy membership if you want to go on regular walks.

    Walking for Prostate Cancer UK

    If you’re interested in walking to raise money for Prostate Cancer UK, you can join one of our organised walks or set up your own walk. Find out more.

     

  • Finding places to exercise  

    You might prefer to use a gym, go to a swimming pool or join an exercise class.

    These organisations can help you find a sports centre, gym or swimming pool near you:

Dealing with fatigue at work

There are laws that protect anyone who has cancer or has had cancer. Even if you no longer have cancer, you are still protected against discrimination.

If you live in England, Scotland or Wales, then the Equality Act protects your rights. If you live in Northern Ireland you have protection under the Disability Discrimination Act.

Under these laws your employer has a duty to make reasonable adjustments to where and how you work, to make sure you get the same chances as the people you work with. For example, a reasonable adjustment could be:

  • giving you time off to go to medical appointments
  • allowing extra breaks if you feel tired
  • changing your job role to remove tasks that cause problems
  • providing suitable toilet facilities.

You can find out more about your rights at work during and after cancer treatment from Macmillan Cancer Support.

What else can help?

If your employer learns more about prostate cancer and its treatment, they might be more understanding. You could show them this website or order our fact sheet, Fatigue and prostate cancer.

Take a look at your company policies and employee handbook. Talk to your occupational health service for advice.

Go to your employer with suggestions about what would help you. For example, taking extra breaks, working from home, flexible hours, or changing your job role or duties for a while.

Know your legal rights. Find out more about the law and make sure your boss or company is aware of it. Contact your union if you are part of one. Citizens Advice can also help.

If you are self-employed or looking for work, you can get more specific information from Macmillan Cancer Support or Disability Rights UK.

Fatigue and relationships

Prostate cancer can change the normal pattern of your life, and affect relationships, friendships and roles within your family. It can bring challenges, but can also bring some couples and families closer together.

If you have fatigue, you might feel too tired to do the things you normally do to look after yourself. You might become more dependent on your partner, family and friends. This can feel frustrating. You might also feel guilty or embarrassed that you can’t do as much as you used to. This can put stress on your relationships. But there are things that you can do to help.

You might find it helpful to:

  • learn more about fatigue together
  • talk about how you feel
  • get support as a family
  • get help with practical matters such as work, money or household tasks
  • develop a wider support network including other family members, friends or health professionals.

Try to make time for family activities, such as holidays and enjoying time together. You may not feel up to some activities that you have done together in the past. But it could be a chance to try something new.

Fatigue and sex

You may not have enough energy for sex. Prostate cancer and treatments for prostate cancer can also cause sexual problems, such as difficulty getting or keeping an erection (erectile dysfunction).

Supporting someone with fatigue

Supporting a partner, friend or family member with fatigue can be very difficult. There are things that might help.

  • Ask your loved one what he feels able to do and support him to do those things.
  • Ask what he doesn’t feel able to do and look into ways you or other people could help with those things.
  • Ask if your loved one would like you to go to hospital appointments with him.
  • Learn more about fatigue so you understand what your loved one is going through.
  • Look into ways to deal with any feelings you might have about your loved one’s fatigue, like feeling frustrated or upset.
  • Make sure you get enough rest so that you have enough energy to support him.
  • Ask friends and family for help.
  • Talk to your doctor for support.

Read more about supporting someone with prostate cancer.

Questions about fatigue to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • Is my prostate cancer treatment likely to cause fatigue?
  • How long might my fatigue last?
  • What can I do to improve or manage my fatigue?
  • What physical activity is suitable for me?
  • Is there a local support group for men with prostate cancer-related fatigue?
  • How can I access a local exercise programme?
  • What other support is available to me?
  • Who can I speak to for advice about work?

References

Updated: November 2016 | Due for Review: November 2018

  • List of references  

    • Alibhai SMH, Gogov S, Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit Rev Oncol Hematol. 2006 Dec;60(3):201–15.
    • Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2016 Apr;69(4):693–703.
    • Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, et al. Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation. J Clin Oncol. 2014 Jun 10;32(17):1840–50.
    • Bower JE. Cancer-related fatigue—mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014 Aug 12;11(10):597–609.
    • Buckley BS, Lapitan MCM. Prevalence of Urinary Incontinence in Men, Women, and Children—Current Evidence: Findings of the Fourth International Consultation on Incontinence. Urology. 2010 Aug;76(2):265–70.
    • Campo RA, Agarwal N, LaStayo PC, O’Connor K, Pappas L, Boucher KM, et al. Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of Qigong. J Cancer Surviv. 2014 Mar;8(1):60–9.
    • Christie Hospital NHS Foundation Trust. Be active, stay active: A guide for exercising during and after treatment for cancer. 2008.
    • Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults.
    • The Cochrane Collaboration, editor. Cochrane Database Syst Rev [Internet]. 2012 Nov 14; Available from: http://doi.wiley.com/10.1002/14651858.CD006145.pub3
    • Dason S. Intermittent androgen deprivation therapy for prostate cancer:translating randomized controlled trials into clinical practice. Can J Urol. 2014;21(Suppl 1):28–36.
    • de Boer AGEM, Verbeek JHAM, Spelten ER, Uitterhoeve ALJ, Ansink AC, de Reijke TM, et al. Work ability and return-to-work in cancer patients. Br J Cancer. 2008 Mar 18;98(8):1342–7.
    • Doyle-Lindrud S. Managing Side Effects of the Novel Taxane Cabazitaxel in Castrate-Resistant Prostate Cancer. Clin J Oncol Nurs. 2012 Jun 1;16(3):286–91.
    • Eastham JA. Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol. 2007 Jan;177(1):17–24.
      Equality Act 2010.
    • Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined Resistance and Aerobic Exercise Program Reverses Muscle Loss in Men Undergoing Androgen Suppression Therapy for Prostate Cancer Without Bone Metastases: A Randomized Controlled Trial. J Clin Oncol. 2010 Jan 10;28(2):340–7.
    • Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol. 2014 Feb 1;32(4):335–46.
    • Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113–24.
    • Garrett K, Dhruva A, Koetters T, West C, Paul SM, Dunn LB, et al. Differences in Sleep Disturbance and Fatigue Between Patients with Breast and Prostate Cancer at the Initiation of Radiation Therapy. J Pain Symptom Manage. 2011 Aug;42(2):239–50.
    • Harden J. Developmental life stage and couples’ experiences with prostate cancer: a review of the literature. Cancer Nurs. 2005 Apr;28(2):85–98.
    • Harden JK, Northouse LL, Mood DW. Qualitative analysis of couples’ experience with prostate cancer by age cohort. Cancer Nurs. 2006 Oct;29(5):367–77.
    • HMSO. Disability Discrimination Act 1995.
      Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-Related Fatigue: The Scale of the Problem. The Oncologist. 2007 May 1;12(suppl_1):4–10.
    • Horneber M, Fischer I, Dimeo F, Ruffer JU, Weis J. Cancer-Related Fatigue. Dtsch Arztebl Int. 2012 Mar;109(9):161–71.
    • Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. J Pain Symptom Manage. 2012 Jan;43(1):96–110.
    • Koornstra RHT, Peters M, Donofrio S, van den Borne B, de Jong FA. Management of fatigue in patients with cancer – A practical overview. Cancer Treat Rev. 2014 Jul;40(6):791–9.
    • Kurzrock R. The role of cytokines in cancer-related fatigue. Cancer. 2001;92(S6):1684–1688.
    • Kyrdalen AE, Dahl AA, Hernes E, Cvancarova M, Foss\aa SD. Fatigue in hormone-naive prostate cancer patients treated with radical prostatectomy or definitive radiotherapy. Prostate Cancer Prostatic Dis. 2010;13(2):144–150.
    • Kyrdalen AE, Dahl AA, Hernes E, Hem E, Fosså SD. Fatigue in prostate cancer survivors treated with definitive radiotherapy and LHRH analogs. The Prostate. 2010 Sep 15;70(13):1480–9.
      Langston B, Armes J, Levy A, Tidey E, Ream E. The prevalence and severity of fatigue in men with prostate cancer: a systematic review of the literature. Support Care Cancer. 2013 Jun;21(6):1761–71.
    • Larkin D, Lopez V, Aromataris E. Managing cancer-related fatigue in men with prostate cancer: A systematic review of non-pharmacological interventions: Managing prostate cancer fatigue. Int J Nurs Pract. 2014 Oct;20(5):549–60.
    • Macmillan Cancer Support. Your rights at work [Internet]. 2013 [cited 2015 Aug 18]. Available from: http://www.macmillan.org.uk/Documents/Cancerinfo/Livingwithandaftercancer/WorkandcancerPDFs/Yourrightsatwork_2013_2.pdf
    • Merriman JD, Dodd M, Lee K, Paul SM, Cooper BA, Aouizerat BE, et al. Differences in Self-reported Attentional Fatigue Between Patients With Breast and Prostate Cancer at the Initiation of Radiation Therapy: Cancer Nurs. 2011 Sep;34(5):345–53.
    • Miles L. Physical activity and health. Nutr Bull. 2007;32(4):314–363.
      Minton O, Jo F, Jane M. The role of behavioural modification and exercise in the management of cancer-related fatigue to reduce its impact during and after cancer treatment. Acta Oncol. 2015 May;54(5):581–6.
    • Morrow GR. Cancer-Related Fatigue: Causes, Consequences, and Management. The Oncologist. 2007 May 1;12(suppl_1):1–3.
    • Mottet N, Bellmunt J, Briers E, Bolla M, Cornford P, De Santis M, et al. Guidelines on prostate cancer. European Association of Urology; 2016.
      National Institute for Clinical Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
    • National Institute for Health and Care Excellence. Physical activity: exercise referral schemes (PH54). 2014.
    • Pachman DR, Price KA, Carey EC. Nonpharmacologic approach to fatigue in patients with cancer. Cancer J. 2014;20(5):313–318.
    • Page MS, Berger AM, Johnson LB. Putting Evidence Into Practice: Evidence-Based Interventions for Sleep-Wake Disturbances. Clin J Oncol Nurs. 2006 Dec 1;10(6):753–67.
    • Pirl WF, Greer JA, Goode M, Smith MR. Prospective study of depression and fatigue in men with advanced prostate cancer receiving hormone therapy. Psychooncology. 2008 Feb;17(2):148–53.
    • Ryan J, Carroll J, Ryan E, Mustian K, Fiscella K, Morrow G. Mechanisms of Cancer-Related Fatigue. The Oncologist. 2007 May;12:22–34.
      Sanofi-Aventis. TAXOTERE® (docetaxel) Injection Concentrate - Prescribing Information. 2014.
    • Singer EA, Srinivasan R. Intravenous therapies for castration-resistant prostate cancer: Toxicities and adverse events. Urol Oncol Semin Orig Investig. 2012 Jul;30(4):S15–9.
    • Stone P, Hardy J, Huddart R, A’Hern R, Richards M. Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer. 2000;36(9):1134–1141.
    • Storey DJ, McLaren DB, Atkinson MA, Butcher I, Frew LC, Smyth JF, et al. Clinically relevant fatigue in men with hormone-sensitive prostate cancer on long-term androgen deprivation therapy. Ann Oncol. 2012;23(6):1542–9.
    • Storey DJ, McLaren DB, Atkinson MA, Butcher I, Liggatt S, O’Dea R, et al. Clinically relevant fatigue in recurrence-free prostate cancer survivors. Ann Oncol. 2012 Jan 1;23(1):65–72.
      The Disability Discrimination (Northern Ireland) Order. 2006.
    • Thompson JC, Wood J, Feuer D. Prostate cancer: palliative care and pain relief. Br Med Bull. 2007;83(1):341–54.
    • Truong PT, Gaul CA, McDonald RE, Petersen RB, Jones SO, Alexander AS, et al. Prospective evaluation of a 12-week walking exercise program and its effect on fatigue in prostate cancer patients undergoing radical external beam radiotherapy. Am J Clin Oncol. 2011;34(4):350–355.
    • Wang XS. Pathophysiology of Cancer-Related Fatigue. Clin J Oncol Nurs. 2008 Jan 1;12(0):11–20.