Understanding and Managing the Symptoms of Advanced Prostate Cancer (video)

Recorded on July 12, 2015

Jeri Kim, MD

Associate Professor, Department of Geritourinary Medicine The University of Texas MD Anderson Cancer Center

Sumit K. Subudhi, MD, PhD

Assistant Professor, Department of Geritourinary Oncology The University of Texas MD Anderson Cancer Center

Zita Dubauskas Lim, PA

Physician Assistant
The University of Texas MD Anderson Cancer Center

Jeff Folloder:

So what are the actual symptoms of advanced prostate cancer, and how do you help patients manage them?

Zita Dubauskas Lim:

Okay. Well, again, even—I think that question also depends a little bit on, again, your journey in the cancer. Whether it’s— are you on—being monitored after surgery alone? Are you on androgen deprivation therapy? Are you perhaps receiving chemo or immunotherapy? Doing each step of this, your symptoms may be different. But I think one common symptom, I think that a lot of patients will express to me, is fatigue.

A lot of patients, a lot of men will also tell us about loss of libido, issues with erectile dysfunction, issues with urinary incontinence, depression. These are all very common symptoms, I think, along the whole spectrum of patients with prostate cancer.

Jeff Folloder:

Let me dial this back just a little bit. The first symptom that you talked about was fatigue. I want to make sure that not just I understand what you’re talking about but everybody in the room talks about. I cut the grass. I trim the hedges. I drink a cold beer. Take a nap. About an hour, hour-and-a-half. Is that fatigue?

Zita Dubauskas Lim:

I don’t—it depends what your baseline is.

If you normally had gone on to mow the other—your neighbor’s lawn on top of that and now you can’t, it’s probably fatigue for you. But I joke, I have a patient who told me, “Yeah, I got really tired because last weekend, I cut down the tree, and I had to carry the logs up the hill and put,” and he was telling me about his fatigue. And I kind of looked at him. I was like, “Well, I’d be tired. Anybody would expect to be tired with that.” But that was new for him.

And so for him, it was still fatigue level for him. And so we tried to address that. Fatigue is a very difficult topic because it can—it’s so multifaceted. There [are] so many different aspects to one’s fatigue. It could be from the hormonal therapy itself, from the therapy itself, but it could also be from other aspects, as depression. Are you anemic? Are you eating properly?

Are you getting enough rest? Maybe you’re not sleeping well, and that’s contributing to your fatigue. So it really takes—it helps to sit down and really kinda tease out what’s your fatigue, and what are your expectations? What would you like to be able to do again?

Jeff Folloder:

So the occasional nap, not such a big deal.

Zita Dubauskas Lim:

No, I think that’s actually a great thing. A power nap is actually, I think, is a recommended thing.

Jeff Folloder:

Medically recommended.

Zita Dubauskas Lim:

But really—medically recommended. I wish I could take a power nap some days during clinic. But yeah, it’s about making it a nap, and not just letting your afternoon nap basically lead into your bedtime. Really making it a very pointed time to rest, but then try to get back to your activities after that.

Jeff Folloder:

But if I’m taking an hour-and-a-half, two-hour, three-hour nap every afternoon, I’m in bed by 8:30, 8:45 PM.

I’m allegedly sleeping till about 8 or 9 in the morning. I’m never quite getting caught up on rest. That’s fatigue.

Dr. Kim:

That’s fatigue. I think we all would agree that that’s real fatigue. And we need to explore a little bit more what’s behind that. Why is that now becoming an issue?

Jeff Folloder:

How do we encourage the patients to actually own up to what’s going on?

Dr. Kim:

Well, as you mentioned, I think it’s always helpful for me to also have the support, the caretaker in the present as well, because you sometimes get two different stories.

I mean, the patient may be, “Oh, I’m doing great,” and then you see the family member in the back turn their head like no, they’re sleeping all the time. And I think it’s partly sometimes patients don’t want to—they feel like they would be disappointing us if they told us that I am having some symptoms, or they’re worried that we’re gonna stop the treatment or reduce the dose if they’re honest about it. So, that—I do encourage the honesty because there are ways to address it.

There are ways to figure out what’s causing the—there may be something medical. Maybe you’ve developed hypothyroidism with all the medicines that we’re giving you, or they may be other issues. With a lot of the immune therapies, we definitely want to know if you’re having significant fatigue, because there could be an impact on your immune system that we need to address urgently. So I encourage everybody—especially, and I think in a clinical trial, that’s

something that we really try to capture. They—you get—part of being in a clinical trial is you get these homework sheets where you have to list all your side effects every day.

And I think it’s important to do that honestly, and just on—like 30 minutes before your clinic to fill it all out, because it shows us a pattern. And sometimes the pattern can tell us what’s wrong, and hopefully, we can address that.

Dr. Subudhi:

What are the symptoms of advanced prostate cancer? It all depends where your prostate cancer’s located. So, for example, I had a patient of MD Anderson, not a patient of mine, who had surgery, felt he was cured from the surgery, and he should’ve been.

But the truth is about 20 percent of patients are not cured. So he stopped checking his PSA regularly. This is a 50-year-old gentleman. And he came to see me because his PSA had jumped to 2,000 from zero. And at this point, he was starting to have symptoms of prostate cancer that’s all over the body. So he had it all over his bones, and so you can imagine, wherever it was located in the bones, he was feeling pain.

Not everyone with prostate cancer in the bone feels pain, but in some people, when it’s untreated for a long time, you can. So this gentleman had difficulty walking, was feeling that not only was the pain localized to where the cancer was in his bone, but there was a nerve-like shooting pain that was extending down to his legs and things like that. You should also know that when prostate cancer is in your spine, that’s not necessarily life-threatening, but in some patients, it is. And it can lead to paralysis.

That’s why it’s very important that we image you regularly. And if you have symptoms where you feel numbness or tingling in your feet, then that should be a cause of alarm. If the prostate cancer’s just in your prostate itself and it’s growing, you’re gonna have a lot of urinary symptoms. What does that mean? Your frequency of which you go to the bathroom is increased, or at night, you’re getting up more often to go to the bathroom. Or some people, they’re having trouble even voiding or getting that urine out, okay?

So these are just some of the common symptoms if it’s just in your prostate. If it’s in your lymph nodes, it’s also dependent on location. For example, if it’s a lymph node here that’s gotten so big, your legs might start swelling, okay? So it all depends on where the prostate cancer is and what kind of symptoms, and that can dictate your symptoms.

Jeff Folloder:

And this symptom load, does this help dictate the specific course of treatment? It’s for you.

Dr. Kim:

Oh. So depending on the symptoms, right. So for example, Dr. Subudhi mentioned cancer in the prostate that can progress. So if that’s the case, we can consider for palliating purpose, putting a urinary catheter in, or—so there are ways to manage the symptoms.

If a patient presents with the bone pain, we can actually spot radiate the bone pain, the bone, to relieve the symptoms. So it really depends on how the patients present with symptoms, depending on where the cancer is. So definitely, there are ways to manage symptoms. So it’ll be very important for patients to communicate with their treating docs and nurse practitioners.