Men who have prostate cancer that has spread to other parts of the body (advanced prostate cancer) might get some of the problems we describe on this page. The symptoms you have will depend on where the cancer has spread to and how quickly it is growing. You might only get a few symptoms and they might not affect you every day. But the cancer might spread further over time, causing symptoms that affect you more.

There are treatments available to help manage symptoms and other things that can help. Find out what can help in our How to manage symptoms and side effects of advanced prostate cancer guide.

If you haven’t been diagnosed with prostate cancer, but want to find out more about what to look out for, you can read our information on signs and symptoms.

Fatigue (extreme tiredness)

Fatigue is a feeling of extreme tiredness that doesn’t go away, even after you rest. It is very common in men with advanced prostate cancer.

Many men are surprised by how tired they feel and by the impact this has on their lives. Fatigue can make it difficult to do everyday tasks. Fatigue can also affect your mood.

Fatigue can be caused by lots of things, including prostate cancer itself, treatments for prostate cancer, stress, anxiety and lack of physical activity.

What can help?

There are lots of things you can do to improve or manage your fatigue, including:

  • talking to your doctor or nurse
  • doing physical activity
  • getting help with emotional problems
  • planning ahead and take things slowly
  • asking for help
  • making time to relax
  • eating and drinking well
  • sorting out your sleep.

Read more about fatigue and ways to improve or manage it.

I found exercise was the best thing to combat fatigue. It motivates you, and keeps your spirits up and stress levels down.

- A personal experience

 

Pain

Pain is a common problem for men with advanced prostate cancer, although some men have no pain at all. The cancer can cause pain in the areas it has spread to. If you do have pain, it can usually be relieved or reduced.

The most common cause of pain is cancer that has spread to the bones. If prostate cancer spreads to the bone, it can damage or weaken the bone and may cause pain. A bone scan can show whether areas of your bones have been weakened. The areas that show up on a scan are sometimes called ‘hot spots’.

Bone pain is a very specific feeling. Some men describe it as feeling similar to a toothache but in the bones, or like a dull aching or stabbing. It can get worse when you move and can make the area tender to touch. Every man’s experience of bone pain will be different. The pain may be constant or it might come and go. How bad it is can also vary and may depend on where the affected bone is.

You might get other types of pain. For example, if the cancer presses on a nerve, this can also cause pain. This might be shooting, stabbing, burning, tingling or numbness.

Pain can also be a symptom of a more serious condition called metastatic spinal cord compression (MSCC).

What can help?

With the right treatment, cancer pain can usually be managed. You shouldn’t have to accept pain as a normal part of having cancer. If you have pain, speak to your doctor or nurse. The earlier pain is treated, the easier it will be to control.

Different types of pain are treated in different ways. Treatments to control pain include:

Other things that might help you manage your pain include:

  • keeping a pain diary to help you describe the pain to your doctor or nurse (download below)
  • looking into complementary therapies
  • eating a healthy diet or taking regular gentle exercise
  • getting emotional support.

To find the best way to deal with your pain, you might have a pain assessment and be referred to a palliative care specialist. Palliative care specialists provide treatment to manage pain and other symptoms of advanced cancer.

Read more about ways to treat and manage pain.

Urinary problems

You might get urinary problems if the cancer is pressing on your urethra or has spread to areas around the prostate, such as the urethra and bladder.

Daigram showing that the prostate sits below the bladder and the bladder is connected to the kidneys.

Problems might include:

  • problems emptying your bladder
  • leaking urine (incontinence)
  • blood in your urine
  • kidney problems.

Some treatments for prostate cancer, such as surgery or radiotherapy, can also cause urinary problems. Read more about managing these problems.

Urinary problems can also be caused by an infection or an enlarged prostate. If you have urinary problems, speak to your doctor or nurse. There are lots of things that can help.

Problems emptying your bladder

If the cancer is pressing on your urethra or the opening of your bladder, you may find it difficult to empty your bladder fully. This is called urine retention. There are several things that can help, including the following.

  • Drugs called alpha-blockers. These relax the muscles around the opening of the bladder, making it easier to urinate.
  • A catheter to drain urine from the bladder. This is a thin, flexible tube that is passed up your penis into your bladder, or through a small cut in your abdomen (stomach area).
  • An operation called a transurethral resection of the prostate (TURP) to remove the parts of the prostate that are pressing on the urethra.

Acute urine retention

This is when you suddenly and painfully can’t urinate – it needs treating straight away. Acute retention isn’t very common in men with advanced prostate cancer. But if it happens, call your doctor or nurse, or go to your nearest accident and emergency (A&E) department. They may need to drain your bladder using a catheter.

Leaking urine

Cancer can grow into the bladder and the muscles that control urination, making the muscles weaker. This could mean you leak urine or need to urinate urgently. Ways to manage leaking urine include:

  • absorbent pads and pants
  • pelvic floor muscle exercises
  • medicines called anti-cholinergics
  • a catheter
  • surgery.

Read more about things to help with leaking urine.

Your treatment options will depend on how much urine you’re leaking and what treatments are suitable for you. Your GP can put you in touch with your local NHS continence service. This is run by specialist nurses and physiotherapists. They can give you advice and support about treatments and products that can help. The Continence Product Advisor website has information about incontinence products. 

If you find you need to rush to the toilet a lot and sometimes leak before you get there, find out where there are public toilets on the Great British Public Toilet Map website. Get our ‘Urgent’ toilet card to show to staff in shops or restaurants – this should make it easier to ask to use their toilet.

Rarely, problems emptying your bladder or leaking urine may be caused by a condition called metastatic spinal cord compression (MSCC).

Blood in your urine

Some men notice blood in their urine (haematuria). This may be caused by bleeding from the prostate. It can be alarming, but can usually be managed. Your doctor might ask you to stop taking medicines that thin your blood, such as aspirin or warfarin. Speak to your doctor or nurse before you stop taking any drugs. You might also be able to have radiotherapy to shrink the cancer and help to stop the bleeding.

Kidney problems

The kidneys remove waste products from your blood and produce urine. Prostate cancer may block the tubes that carry urine from the kidneys to the bladder (ureters). This can affect how well your kidneys work. Prostate cancer and some treatments can also make it difficult to empty your bladder (urine retention). This can stop your bladder and kidneys from draining properly, which can cause kidney problems.

Severe kidney problems can lead to high levels of waste products in your blood, which can be harmful. Symptoms include tiredness and lack of energy, feeling sick, swollen ankles and feet, and poor appetite. If you have any of these symptoms tell your doctor or nurse. A blood test can check how well your kidneys are working.

Treatments that can help to drain urine from the kidneys include:

  • a tube put into the kidney to drain urine into a bag outside your body (nephrostomy)
  • a tube (called a stent) put inside the ureter to allow urine to flow from the kidney to the bladder
  • radiotherapy to shrink the cancer and reduce the blockage.    

If you have kidney problems caused by urine retention, you may need a catheter to drain urine from the bladder.

Getting support for urinary problems

Urinary problems might affect how you feel about yourself and your sense of independence. If you are finding them hard to deal with, speak to your doctor or nurse.

Bowel problems

Bowel problems can include:

  • difficulty emptying your bowels (constipation)
  • passing loose and watery bowel movements (diarrhoea)
  • needing to rush to the toilet (faecal urgency)
  • leaking from your back passage (faecal incontinence)
  • pain around your abdomen (stomach area) or back passage
  • being unable to empty your bowels (bowel obstruction)
  • passing a lot of wind (flatulence).

Speak to your doctor or nurse if you have any of these symptoms. There are treatments available that may help.

Men with advanced prostate cancer can get bowel problems for a variety of reasons. Radiotherapy to the prostate and surrounding area can cause bowel problems. You might get these during treatment, or they can develop months or years later.

Pain-relieving drugs such as morphine and codeine can cause constipation. Don’t stop taking them, but speak to your doctor or nurse if you have any problems.

Becoming less mobile, changes to your diet, and not drinking enough fluids can also cause constipation.

You may also get bowel problems if prostate cancer spreads to your lower bowel (rectum), but this isn’t common. If it happens, it can cause symptoms including constipation, pain, bleeding and, rarely, being unable to empty your bowels.

Problems emptying your bowels or leaking from your back passage might sometimes be caused by a condition called metastatic spinal cord compression (MSCC).

What can help?

Lifestyle changes

Speak to your doctor or nurse about whether changing your diet could help with these problems. They may refer you to a dietitian, who can help you make changes to your diet.

If you have constipation, eating lots of high fibre foods can help. These include fruit such as prunes, wholemeal bread, wholegrain breakfast cereals and porridge. Drink plenty of water. Aim for about two litres (eight glasses) of water a day.  Gentle exercise such as going for a walk can also help with constipation.

If you have diarrhoea, eating less fibre for a short time may help. Low fibre foods include white rice, pasta and bread, potatoes (without the skins), cornmeal, eggs and lean white meat. Drink plenty of fluids, but avoid alcohol, coffee and fizzy drinks. Avoiding spicy food and eating fewer dairy products, such as milk and cheese, may also help.

Read more about maintaining a healthy diet.

Medicines or treatments

If you have constipation, your doctor or nurse may prescribe laxatives to help you empty your bowels. If you have constipation or bowel obstruction caused by prostate cancer, they might recommend radiotherapy to the bowel.

Information and support

Living with bowel problems can be distressing and difficult to talk about. But health professionals are used to discussing these problems and can help you find ways to deal with them. You could also ask your GP to refer you to your local continence service. Their specialist nurses can give you further support and information on products that can help.

Macmillan Cancer Support has more information about coping with bowel problems.

Broken bones (fractures)

The most common place for prostate cancer to spread to is the bones. The cancer can damage bones, making them weaker. And some types of hormone therapy can also make your bones weaker. You might hear this called bone thinning. If bone thinning is severe, it can lead to a condition called osteoporosis. This can increase your risk of broken bones (fractures). Read more about bone thinning and hormone therapy.

Damage to the bones can make it difficult or painful to move around. You may not be able to do some of the things that you used to do because you’re in pain, or because you might be more likely to break a bone. This can be hard to accept.

What can help?

You might be given radiotherapy to slow down the growth of the cancer. This can help control damage to the bones and relieve bone pain.

Your doctor may offer you drugs called bisphosphonates. These can strengthen the bones and help prevent broken bones in men whose cancer has caused bone thinning. Bisphosphonates can also be used to treat pain caused by cancer that has spread to the bones.

If there is an area of bone that has been badly damaged, surgery might help to strengthen it. A metal pin or plate is put inside the bone. Surgery isn’t suitable for all men with advanced prostate cancer. This will depend on where the damaged bone is, and other things such as whether you are well enough for surgery. If you have an operation, you may have radiotherapy afterwards to help stop the cancer growing in that area.

Even though you may not be able to do some physical activities, staying active can help with your general health and your ability to move around. Speak to your doctor, nurse or physiotherapist about what you can and can’t do.

Read more about fragile bones on the National Osteoporosis Society website.

Sexual problems

Dealing with advanced prostate cancer can have an impact on your sex life. You might lose interest in sex or not have enough energy for it. Getting an erection relies on your desire for sex (libido), which can be affected by your thoughts and feelings. So feeling low, anxious or tired can also affect your sex life.

All types of hormone therapy can reduce your desire for sex, and affect your ability to get or keep an erection. Other treatments for prostate cancer, such as surgery or radiotherapy, can also cause erection problems.

What can help?

You can get free medical treatment and support for sexual problems on the NHS. Speak to your GP, nurse or hospital doctor to find out more. They can offer you treatment or refer you to a specialist service.

If you’re on hormone therapy and have lost your desire for sex (libido), this might not come back. Some treatments may still help with your erections, even if your sex drive is low.

If you’re on long-term hormone therapy, you may be able to have intermittent hormone therapy. This is where you stop hormone therapy when your PSA level is low and steady, and start it again if your PSA rises. Your sex drive may improve while you’re not having hormone therapy. But it can take several months and some men don’t notice any improvement.

Your sex life might not be the same as it was before cancer, and you may need some support accepting this. You don’t have to give up on having pleasure, closeness or fun. You could explore other ways to be intimate, such as hugging and holding each other. If you have a partner, talking about sex, your thoughts and feelings can help you both deal with any changes.

If you are in a relationship you may need time alone together, whatever your situation. If you are in a hospital, hospice or have carers coming to your house, make sure they know when you need some private time together.

If you have a catheter to help manage urinary problems, it is still possible to have sex. Speak to your nurse about this.

 Read more about sex and relationships.

Lymphoedema

If the cancer spreads to the lymph nodes it could lead to a condition called lymphoedema – caused by a blockage in the lymphatic system. The lymphatic system is part of your body’s immune system, carrying fluid called lymph around your body. If it is blocked, the fluid can build up and cause swelling (lymphoedema). Prostate cancer can cause the blockage, and so can some treatments such as surgery or radiotherapy. Lymphoedema can occur months or even years after treatment.

Lymphoedema in prostate cancer usually affects the legs, but it can affect other areas, including the penis or scrotum (the skin around your testicles). Symptoms in the affected area can include:

  • swelling
  • pain, discomfort or heaviness
  • inflammation, redness or infection
  • tight or sore skin.

Lymphoedema can affect your daily life. You might be less able to move around and find it harder to carry out everyday tasks. Some men worry about how the affected area looks and feel anxious about other people seeing it.

What can help?

Speak to your nurse or GP if you have any symptoms. There are treatments that can help to manage them. Treatments aim to reduce or stop the swelling and make you more comfortable. They are most effective if you start them when you first get symptoms. If you have lymphoedema, you may be referred to a specialist lymphoedema nurse, who can show you how to manage the swelling. They are often based in hospices.

There are a variety of things that might help.

  • Caring for the skin, such as regular cleaning and moisturising, can help to keep your skin soft and reduce the chance of it becoming cracked and infected.
  • Special massage (manual lymphatic drainage) can help to increase the flow of lymph. Your nurse might be able to show you or a partner, family member or friend how to do this.
  • Gentle exercise may help to improve the flow of lymph from the affected area of the body. For example, doing simple leg movements, similar to those recommended for long aeroplane journeys, may help with leg lymphoedema.
  • Using compression bandages or stockings can help to encourage the lymph to drain from the affected area. Your nurse will show you how to use them.
  • Wearing close-fitting underwear or lycra cycling shorts may help control any swelling in your penis or scrotum.
  • Try to maintain a healthy weight as being overweight can make lymphoedema harder to manage. Read more about diet and physical activity.

Living with lymphoedema can be difficult. If you need practical or emotional support, speak to your nurse or GP. Your GP can also refer you to a counsellor to help you deal with how you’re feeling.

Macmillan Cancer Support and the Lymphoedema Support Network provide more information and can put you in touch with local support groups.

Anaemia

Some men with advanced prostate cancer may develop a condition called anaemia. This is when your blood can’t carry enough oxygen to meet your body’s needs. Symptoms include feeling tired or weak, being out of breath and looking pale.

Anaemia is caused by a drop in the number of red blood cells, which means not enough oxygen is carried around the body. Anaemia can happen when your bone marrow is damaged – either by the prostate cancer or by treatment such as hormone therapy, chemotherapy or radiotherapy.

Sometimes anaemia is caused by a lack of iron in your diet. You might be more at risk of this if you have problems eating.

What can help?

Speak to your doctor or nurse if you have symptoms of anaemia. You will have a blood test to check your red blood cell levels. Which treatment you’re offered will depend on what’s causing your anaemia.

Your doctor may recommend you take iron supplements to help with anaemia. These can cause constipation – see above for ways to manage this. If you have very low levels of red blood cells, you may need a blood transfusion. This can be a quick and effective way of treating anaemia.

Macmillan Cancer Support provides more information about anaemia and blood transfusions.

 

 

Metastatic spinal cord compression (MSCC)

Metastatic spinal cord compression (MSCC) happens when cancer cells grow in or near to the spine and press on the spinal cord. MSCC isn’t common, but you need to be aware of the risk if your prostate cancer has spread to your bones or has a high risk of spreading to your bones. The risk of MSCC is highest if the cancer has already spread to the spine. Speak to your doctor or nurse for more information about your risk.

MSCC can cause any of the following symptoms.

  • Pain or soreness in your lower, middle or upper back or neck. The pain may be severe or get worse over time. It might get worse when you cough, sneeze, lift or strain, or go to the toilet. It might get worse when you are lying down. It may wake you at night or stop you from sleeping.
  • A narrow band of pain around your abdomen (stomach area) or chest that can move towards your lower back, buttocks or legs.
  • Pain that moves down your arms or legs.
  • Weakness in your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
  • Numbness or tingling (pins and needles) in your legs, arms, fingers, toes, buttocks, stomach area or chest, that doesn’t go away.
  • Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

These symptoms can also be caused by other conditions, but it’s still important to get medical advice straight away in case you do have MSCC. If your doctor or nurse isn’t available, go to your nearest accident and emergency (A&E) department.

Don’t wait

It is very important to seek medical advice immediately if you think you might have MSCC. The sooner you have treatment, the lower your risk of long-term problems.

Don’t wait to see if it gets better and don’t worry if it’s an inconvenient time, such as the evening or weekend. At its worst, MSCC can cause paralysis, which could mean you can’t walk or use your arms or legs normally. Getting treatment straight away can lower the risk of this happening, or of it being permanent.

Read more about metastatic spinal cord compression (MSCC).

 

Hypercalcaemia

Hypercalcaemia is a high level of calcium in your blood. Calcium is usually stored in the bones, but the cancer can cause calcium to leak into the blood. This isn’t common in men with advanced prostate cancer. But if it happens, it’s important that it’s treated so it doesn’t develop into a more serious condition.

Hypercalcaemia doesn’t always cause symptoms, but it can cause:

  • bone pain
  • tiredness, weakness or lack of energy
  • loss of appetite
  • difficulty emptying your bowels (constipation)
  • confusion
  • feeling and being sick (nausea and vomiting)
  • pain in your lower stomach area
  • feeling more thirsty than usual
  • needing to urinate often (frequency).

These symptoms can be quite common in men with advanced prostate cancer and might not be caused by hypercalcaemia. Tell your doctor or nurse if you have any of these symptoms. They may do some tests to find out what is causing them, including a blood test to check the level of calcium in your blood.

What can help?

You may have to go into hospital or a hospice for a couple of days. You will be given fluid through a drip in your arm. This will help to flush calcium out of your blood and bring your calcium levels down.

Drugs called bisphosphonates can help treat hypercalcaemia. They are very effective at lowering calcium in your blood. They usually start to work in two to four days. If your blood calcium levels are still high, you may be given another dose of bisphosphonates after a week. 

Once your calcium levels are back to normal, you will have regular blood tests to keep an eye on them. Tell your doctor or nurse if your symptoms come back.

Cancer Research UK has more information about hypercalcaemia.

Eating problems

Some men with advanced prostate cancer have problems eating, or have a poor appetite. You might feel or be sick. These problems may be caused by your cancer or by your treatments.  Being worried about things can also affect your appetite.

Problems eating or loss of appetite can lead to weight loss and can make you feel very tired and weak. Advanced prostate cancer can also cause weight loss by changing the way your body uses energy.

What can help?

If you feel sick because of your treatment, your doctor can give you anti-sickness drugs. Steroids can also increase your appetite and are sometimes given along with other treatments.

Try to eat small amounts regularly. If you’re struggling to eat because of nausea (feeling sick), try to avoid strong smelling foods. It may help if someone cooks for you. Try to eat when you feel less sick, even if it’s not your usual mealtime. Fatty and fried foods can make sickness worse. Drink plenty of water, but drink slowly and try not to drink too much before you eat.

Tell your doctor if you lose weight. They can refer you to a dietitian who can provide advice about high calorie foods and any supplements that might help. It can be upsetting for your family to see you losing weight, and they may also need support. Macmillan Cancer Support and Marie Curie provide support and information about eating problems in advanced cancer.

Treatments

Treatments for advanced prostate cancer

Men who’ve recently been diagnosed with advanced prostate cancer are usually offered hormone therapy, sometimes with chemotherapy.

Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again. If this happens you might be offered another type of hormone therapy or chemotherapy. Or you might be offered another treatment, such as radium-223 (Xofigo®), or treatment on a clinical trial. There are also specific treatments to help manage symptoms caused by advanced prostate cancer, including pain-relieving drugs, radiotherapy and bisphosphonates.

Read more about treatment options after your first hormone therapy.

Pain-relieving drugs

Pain-relieving drugs include tablets, patches and injections. Your doctor or palliative care nurse will help you find what’s best for you.

Some men worry about becoming addicted to pain-relieving drugs. But it’s uncommon for men with prostate cancer to become addicted to pain-relieving drugs.

Read more about managing pain in advanced prostate cancer.

Radiotherapy

Radiotherapy can help control symptoms by slowing down the growth of the cancer. This is sometimes called palliative radiotherapy. It can help to manage symptoms such as pain, blood in your urine or discomfort from swollen lymph nodes. It’s also used to treat metastatic spinal cord compression.

You might experience an increase in pain during, and for a few days after, treatment but this should soon improve. It usually takes a few weeks for radiotherapy to have its full effect.

There are two types of radiotherapy used to reduce symptoms.

  • External beam radiotherapy. This is where high-energy X-ray beams are directed at the area of pain from outside the body. Radiotherapy for advanced prostate cancer uses less radiation overall than radiotherapy for earlier stages of prostate cancer. The course of treatment is also often shorter. It’s sometimes called short-course radiotherapy.
  • Radioisotopes. A very small amount of a radioactive liquid is injected into a vein in your arm and collects in bones that have been damaged by prostate cancer. It kills the cancer cells in the bones, but doesn’t damage many surrounding healthy cells. A radioisotope called radium-223 (Xofigo®) can help reduce bone pain. It can also help some men live longer and delay some symptoms, such as bone fractures.

Read more about radiotherapy for advanced prostate cancer.

Bisphosphonates

Bisphosphonates are drugs that are sometimes used to help relieve and prevent further bone pain in men with advanced prostate cancer. Bisphosphonates can also be used to manage bone thinning caused by hormone therapy, or to help prevent and slow down further bone damage. They can also be used to treat a condition called hypercalcaemia. Read more about bisphosphonates.

Complementary therapies

Complementary therapies may be used alongside medical treatment. They include acupuncture, massage, yoga, meditation, reflexology and hypnotherapy. Some people find they help them deal with cancer symptoms and side effects of treatment, such as tiredness.

Some complementary therapies 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, as part of the care they provide. But if you want to find a therapist yourself, make sure they are properly qualified and belong to a professional body. The Complementary and Natural Healthcare Council have advice about finding a therapist.

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

Your health and social care professionals

You might see a range of different professionals to help manage your symptoms and offer emotional and practical support. Some may have been treating you since your diagnosis. Others provide specific services or specialise in palliative care.

Your multi-disciplinary team (MDT)

This is the team of health professionals involved in your care. Your MDT is likely to include a specialist nurse, oncologist, urologist, radiologist, therapeutic radiographer, and a palliative care doctor or nurse. It may also include other health professionals, such as a dietitian or physiotherapist. Services can vary depending on where you live. Read more about people in your MDT.

Your GP, practice nurse and district nurse

Your GP, practice nurse, and district or community nurse will work with other health professionals to co-ordinate your care and offer you support and advice. They can also refer you to local services. They can visit you in your home and also help support your family. They might also care for you if you go into a nursing home or hospice.

Palliative care team

This includes specialist doctors and nurses who provide treatment to manage pain and other symptoms of advanced cancer. They also provide emotional, physical, practical and spiritual support for you and your family. You might hear this called symptom control or supportive care. They work in hospitals and hospices, and they might be able to visit you at home. Your hospital doctor, nurse or GP can refer you to a palliative care team. Read more about palliative care.

Hospices

Hospices provide a range of services for men with advanced prostate cancer, and their family and friends. They can provide treatment to manage symptoms as well as emotional, spiritual, psychological, practical and social support.

Hospices don’t just provide care for people at the end of their life. Some people go into a hospice for a short time to get their symptoms under control then go home again. Most hospices have nurses who can visit you at home, and some provide day care. This means you can use their services while still living at home. Read more about hospice care.

Hospitals  

Many men with advanced prostate cancer stay in hospital at some point. Some men decide to go into hospital to help get their symptoms under control. Other men have to go into hospital if their symptoms suddenly get worse. This can be distressing or upsetting, but it may be the best way to get the care you need. If you’re admitted to hospital, this may just be for a few days or it might be for longer.

Other professionals who can help

Your doctor, nurse or GP can refer you to these professionals.

  • Physiotherapists can help with mobility and provide exercises to help improve fitness or ease pain. This can help you stay independent for longer.
  • Counsellors, psychologists or psychotherapists can help you and your family work through any difficult feelings and find ways of coping.
  • Dietitians can give you advice about healthy eating, which might help with fatigue and staying a healthy weight. They can also help if you are losing weight or havingproblems eating.
  • Occupational therapists can provide advice and access to equipment and adaptations to help with daily life. For example, help with dressing, eating, bathing or using the stairs. Your social services department or your GP should be able to arrange for an occupational therapist to visit you.
  • Social services,including social workers, can providepractical and financial advice and access to emotional support. They can give you advice about practical issues such as arranging for someone to support you at home.What’s available varies from place to place. Your GP, hospital doctor or nurse might be able to refer you to some services. You can also contact your local social services department yourself. Their telephone number will be in the phonebook under the name of your local authority, on their website and at the town hall.

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References

Updated: March 2017 | Due for Review: March 2019

  • List of references  

    • Abel J, Pring A, Rich A, Malik T, Verne J. The impact of advance care planning of place of death, a hospice retrospective cohort study. BMJ Support Palliat Care. 2013;3(2):168–173.
    • Alsadius D, Olsson C, Pettersson N, Tucker SL, Wilderäng U, Steineck G. Patient-reported gastrointestinal symptoms among long-term survivors after radiation therapy for prostate cancer. Radiother Oncol. 2014 Aug;112(2):237–43.
    • Bahl A, Oudard S, Tombal B, Ozguroglu M, Hansen S, Kocak I, et al. Impact of cabazitaxel on 2-year survival and palliation of tumour-related pain in men with metastatic castration-resistant prostate cancer treated in the TROPIC trial. Ann Oncol. 2013 May 30;24(9):2402–8.
    • Bancroft J, Janssen E, Strong D, Carnes L, Vukadinovic Z, Long JS. The Relation Between Mood and Sexuality in Heterosexual Men. Arch Sex Behav. 2003 Jun 1;32(3):217–30.
    • Beck AM, Robinson JW, Carlson LE. Sexual intimacy in heterosexual couples after prostate cancer treatment: What we know and what we still need to learn. Urol Oncol Semin Orig Investig. 2009 Mar;27(2):137–43.
    • Berkey FJ. Managing the adverse effects of radiation therapy. Am Fam Physician. 2010 Aug 15;82(4):381–8, 394.
    • Botrel TEA, Clark O, dos Reis RB, Pompeo ACL, Ferreira U, Sadi MV, et al. Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis. BMC Urol. 2014;14:9.
    • 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.
    • British Pain Society. Cancer pain management: a perspective from the British Pain Society, supported by the Association for Palliative Medicine and the Royal College of General Practitioners. London: British Pain Soc.; 2010.
    • British Uro-oncology Group (BUG), British Association of Urological Surgeons (BAUS). Multi-disciplinary Team (MDT) Guidance for Managing Prostate Cancer. 2013.
    • Bubendorf L, Schöpfer A, Wagner U, Sauter G, Moch H, Willi N, et al. Metastatic patterns of prostate cancer: An autopsy study of 1,589 patients. Hum Pathol. 2000 May;31(5):578–83.
    • Cancer Research UK. Prostate cancer 5 year survival by stage. 2014.
    • Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The supportive care needs of men with advanced prostate cancer. In: Oncology nursing forum [Internet]. Onc Nurs Society; 2011 [cited 2014 Dec 11]. p. 189–198. Available from: http://ons.metapress.com/index/G82215H56920T680.pdf
    • Clarke NW. Management of the Spectrum of Hormone Refractory Prostate Cancer. Eur Urol. 2006 Sep;50(3):428–39.
    • Collins R, Trowman R, Norman G, Light K, Birtle A, Fenwick E, et al. A systematic review of the effectiveness of docetaxel and mitoxantrone for the treatment of metastatic hormone-refractory prostate cancer. Br J Cancer. 2006 Aug 1;95(4):457–62.
    • Colloca G, Venturino A, Checcaglini F. Patient-reported outcomes after cytotoxic chemotherapy in metastatic castration-resistant prostate cancer: A systematic review. Cancer Treat Rev. 2010 Oct;36(6):501–6.
    • Compassion in Dying. AD01 Understanding Advance Decisions - England and Wales [Internet]. [cited 2014 Apr 10]. Available from: http://www.compassionindying.org.uk/sites/default/files/AD01%20Understanding%20Advance%20Decisions%20-%20England%20and%20Wales.pdf
    • Compassion in Dying. AD05 Talking to your doctor about your Advance Decision_1.pdf [Internet]. [cited 2014 Oct 3]. Available from: http://www.compassionindying.org.uk/sites/default/files/AD05%20Talking%20to%20your%20doctor%20about%20your%20Advance%20Decision_1.pdf
    • 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
    • Curtis KK, Adam TJ, Chen S-C, Pruthi RK, Gornet MK. Anaemia following initiation of androgen deprivation therapy for metastatic prostate cancer: A retrospective chart review. Aging Male. 2008 Jan;11(4):157–61.
    • De Sousa A, Sonavane S, Mehta J. Psychological aspects of prostate cancer: a clinical review. Prostate Cancer Prostatic Dis. 2012 Jun;15(2):120–7.
    • Dorff TB, Crawford ED. Management and challenges of corticosteroid therapy in men with metastatic castrate-resistant prostate cancer. Ann Oncol. 2013 Jan 1;24(1):31–8.
    • Eastham JA. Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol. 2007 Jan;177(1):17–24.
    • Elliott S, Latini DM, Walker LM, Wassersug R, Robinson JW. Androgen Deprivation Therapy for Prostate Cancer: Recommendations to Improve Patient and Partner Quality of Life: Improving Life on ADT. J Sex Med. 2010 Sep;7(9):2996–3010.
    • 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.
    • 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.
    • Hechtman LM. Clinical Naturopathic Medicine [Internet]. Harcourt Publishers Group (Australia); 2014 [cited 2015 Jul 21]. 1610 p. Available from: http://www.bookdepository.com/Clinical-Naturopathic-Medicine-Leah-Hechtman/9780729541923
    • Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. The Cochrane Collaboration, editor. Cochrane Database Syst Rev [Internet]. 2013 [cited 2014 Nov 18];(11). Available from: http://doi.wiley.com/10.1002/14651858.CD009896.pub2
    • 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.
    • Hospice UK. What is hospice care? [Internet]. Available from: http://www.hospiceuk.org/about-hospice-care/what-is-hospice-care
    • Husson O, Mols F, Poll-Franse LV van de. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol. 2010 Sep 24;mdq413.
    • James ND, Spears MR, Clarke NW, Dearnaley DP, De Bono JS, Gale J, et al. Survival with Newly Diagnosed Metastatic Prostate Cancer in the ‘Docetaxel Era’: Data from 917 Patients in the Control Arm of the STAMPEDE Trial (MRC PR08, CRUK/06/019). Eur Urol. 2015 Jun;67(6):1028–38.
    • James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. The Lancet. 2015 Dec;
    • 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.
    • 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.
    • 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.
    • Li KK, Hadi S, Kirou-Mauro A, Chow E. When Should we Define the Response Rates in the Treatment of Bone Metastases by Palliative Radiotherapy? Clin Oncol. 2008 Feb;20(1):83–9.
    • Loblaw DA, Mitera G, Ford M, Laperriere NJ. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression. Int J Radiat Oncol. 2012;84(2):312–7.
    • Loblaw DA, Perry J, Chambers A, Laperriere NJ. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: The Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group. J Clin Oncol. 2005;23(9):2028–37.
    • Magnan S, Zarychanski R, Pilote L, Bernier L, Shemilt M, Vigneault E, et al. Intermittent vs Continuous Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2015 Sep 17;1–10.
    • Marie Curie Cancer Care. Difficult conversations with dying people and their families [Internet]. 2014. Available from: http://www2.mariecurie.org.uk/ImageVaultFiles/id_1956/cf_100/Difficult-Conversations_report.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.
    • 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.
    • Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;8:CD007566.
    • 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.
    • Nalesnik JG, Mysliwiec AG, Canby-Hagino E. Anemia in men with advanced prostate cancer: incidence, etiology, and treatment. Rev Urol. 2004;6(1):1.
    • National End of Life Care Intelligence Network. What we know now 2014. Public Health England; 2015.
    • National Institute for Clinical Excellence. NICE guideline 31: Care of dying adults in the last days of life [Internet]. NICE; 2015. Available from: http://www.nice.org.uk/guidance/ng31/resources/care-of-dying-adults-in-the-last-days-of-life-1837387324357
    • National Institute for Clinical Excellence. Osteoporosis - prevention of fragility fractures - Clinical Knowledge Summary [Internet]. 2016. Available from: http://cks.nice.org.uk/osteoporosis-prevention-of-fragility-fractures#!scenario:1
    • National Institute for Clinical Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
    • National Institute for Health and Care Excellence (NICE). Metastatic spinal cord compression in adults - quality standard 56. 2014.
    • National Institute for Health and Care Excellence. Docetaxel for the treatment of hormone-refractory prostate cancer. NICE; 2006.
    • National Institute for Health and Care Excellence. Hypercalcaemia: Clinical Knowledge Summary [Internet]. 2014 [cited 2016 Oct 6]. Available from: http://cks.nice.org.uk/hypercalcaemia
    • National Institute for Health and Care Excellence. Metastatic spinal cord compression: Diagnosis and management of adults at risk of and with metastatic spinal cord compression. NICE clinical guideline 75 [Internet]. 2008. Available from: https://www.nice.org.uk/guidance/cg75
    • National Institute for Health and Care Excellence. Neuropathic pain – pharmacological management: The pharmacological management of neuropathic pain in adults in non-specialist settings [Internet]. 2013 [cited 2014 Jul 17]. Available from: http://www.nice.org.uk/guidance/CG173/chapter/introduction
    • National Institute for Health Research. Better Endings: Right care, right place, right time. [Internet]. 2015. Available from: http://www.dc.nihr.ac.uk/__data/assets/file/0005/157037/Better-endings-FINAL-DH-single-page.pdf
    • NHS Choices. End of life care: What it involves and when it starts [Internet]. National Health Service. 2015 [cited 2016 May 1]. Available from: http://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx
    • NHS Choices. End of life care: Why plan ahead? [Internet]. 2014 [cited 2016 May 1]. Available from: http://www.nhs.uk/Planners/end-of-life-care/Pages/why-plan-ahead.aspx
    • NHS England. Clinical Commissioning Policy Statement: Docetaxel in combination with androgen deprivation therapy for the treatment of hormone naive metastatic prostate cancer. 2016.
    • NHS National End of Life Care Programme. Deaths from urological cancers in England 2001-2010 [Internet]. 2012 Nov. Available from: http://www.endoflifecare-intelligence.org.uk/resources/publications/deaths_from_urological_cancers
    • Pachman DR, Price KA, Carey EC. Nonpharmacologic approach to fatigue in patients with cancer. Cancer J. 2014;20(5):313–318.
    • Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, et al. Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer. N Engl J Med. 2013;369(3):213–23.
    • Parsons BA, Evans S, Wright MP. Prostate cancer and urinary incontinence. Maturitas. 2009;63(4):323–8.
    • Patrick DL, Cleeland CS, von Moos R, Fallowfield L, Wei R, Öhrling K, et al. Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents. Support Care Cancer [Internet]. 2014 Dec 23 [cited 2015 Feb 18]; Available from: http://link.springer.com/10.1007/s00520-014-2525-4
    • Pettersson A, Johansson B, Persson C, Berglund A, Turesson I. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: A randomized controlled trial in prostate cancer patients undergoing radiotherapy. Radiother Oncol. 2012 Jun;103(3):333–40.
    • Ryan J, Carroll J, Ryan E, Mustian K, Fiscella K, Morrow G. Mechanisms of Cancer-Related Fatigue. The Oncologist. 2007 May;12:22–34.
    • Samphao S, Eremin JM, Eremin O. Oncological emergencies: clinical importance and principles of management. Eur J Cancer Care (Engl). 2010;19(6):707–13.
    • Schaake W, Wiegman EM, de Groot M, van der Laan HP, van der Schans CP, van den Bergh ACM, et al. The impact of gastrointestinal and genitourinary toxicity on health related quality of life among irradiated prostate cancer patients. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2014 Feb;110(2):284–90.
    • Serpa Neto A, Tobias-Machado M, Esteves MAP, Senra MD, Wroclawski ML, Fonseca FLA, et al. Bisphosphonate therapy in patients under androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2012;15(1):36–44.
    • Serpa Neto A, Tobias-Machado M, Kaliks R, Wroclawski ML, Pompeo ACL, Del Giglio A. Ten Years of Docetaxel-Based Therapies in Prostate Adenocarcinoma: A Systematic Review and Meta-Analysis of 2244 Patients in 12 Randomized Clinical Trials. Clin Genitourin Cancer. 2011 Dec;9(2):115–23.
    • 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.
    • 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.
    • Thompson JC, Wood J, Feuer D. Prostate cancer: palliative care and pain relief. Br Med Bull. 2007;83:341–54.
    • Tillisch K. Complementary and alternative medicine for functional gastrointestinal disorders. Gut. 2006 May 1;55(5):593–6.
    • Todd M. Understanding lymphoedema in advanced disease in a palliative care setting. Int J Palliat Nurs. 2009;15(10):474.
    • Tucci M, Bertaglia V, Vignani F, Buttigliero C, Fiori C, Porpiglia F, et al. Addition of Docetaxel to Androgen Deprivation Therapy for Patients with Hormone-sensitive Metastatic Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2015 Sep;
    • Vale CL, Burdett S, Rydzewska LH, Albiges L, Clarke NW, Fisher D, et al. Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data. Lancet Oncol. 2015;
    • Walji N, Chan AK, Peake DR. Common acute oncological emergencies: diagnosis, investigation and management. Postgrad Med J. 2008 Aug 1;84(994):418–27.
    • Wang XS. Pathophysiology of Cancer-Related Fatigue. Clin J Oncol Nurs. 2008 Jan 1;12(0):11–20.
    • Watson M, Lucas C, Hoy A, Back I, Armstrong P. Palliative care adult network guidelines [Internet]. 3rd Edition. 2011. Available from: http://book.pallcare.info/index.php?user_style=1
    • Wedlake LJ, Shaw C, Whelan K, Andreyev HJN. Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther. 2013 Jun;37(11):1046–56.
    • Yuen KK, Shelley M, Sze WM, Wilt TJ, Mason M. Bisphosphonates for advanced prostate cancer (Review). Cochrane Database Syst Rev. 2006;(4).
    • Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol. 2008;70(4):1124–9.