These quick reference cards summarize the most common side effects of prostate cancer treatment and what you can do about them. Tear out or photocopy the cards most relevant to your treatment. Always discuss any new or worsening symptoms with your doctor.
Card G.1 — Urinary Leakage (Incontinence)
Most common after: Surgery (radical prostatectomy)
What to expect:
- Very common in the first weeks after catheter removal
- Most men improve significantly over 3–12 months
- Some men recover fully; others may have mild stress leakage long-term
What you can do:
- Pelvic floor exercises (Kegels): The single most important thing you can do
- Tighten the muscles you would use to stop urine mid-stream
- Hold for 5 seconds, relax for 5 seconds
- Repeat 10–15 times, 3 times per day
- Start before surgery if possible
- Use pads: Start with heavier pads, transition to lighter ones as you improve
- Limit caffeine and alcohol: Both can worsen urgency and frequency
- Time your fluids: Drink steadily during the day; reduce fluids 2–3 hours before bed
- Bladder training: Try to gradually increase the time between bathroom visits
- Maintain a healthy weight: Extra weight puts pressure on the pelvic floor
When to call your doctor:
- No improvement after 3–6 months
- Leakage is severe and not improving
- Pain or burning with urination
- Blood in urine
Medical options if exercises are not enough:
- Pelvic floor physical therapy with a specialist
- Biofeedback training
- Urethral sling procedure
- Artificial urinary sphincter (AUS)
Card G.2 — Urinary Urgency, Frequency, and Burning
Most common after: Radiation therapy (EBRT, brachytherapy, SBRT)
What to expect:
- Usually begins 2–4 weeks into radiation treatment
- Peaks near the end of treatment or shortly after
- Most symptoms improve within 2–3 months after treatment ends
- Rarely, some symptoms may persist long-term
What you can do:
- Drink plenty of water: Concentrated urine irritates the bladder more
- Avoid bladder irritants: Caffeine, alcohol, spicy foods, acidic foods (tomatoes, citrus), carbonated drinks
- Eat a low-residue diet during treatment if bowel symptoms are also present
- Take prescribed medications: Your doctor may prescribe tamsulosin (Flomax) or other medications to ease urinary flow
- Warm sitz baths: Can soothe discomfort
- Over-the-counter options: Phenazopyridine (Azo) can help with burning — ask your doctor first
When to call your doctor:
- Unable to urinate for more than 8 hours
- Fever with urinary symptoms (possible infection)
- Blood in urine
- Symptoms worsening instead of improving after treatment ends
Card G.3 — Erectile Dysfunction (ED)
Most common after: Surgery, radiation, and hormone therapy (all treatments can cause ED)
What to expect:
- After surgery: ED is immediate; recovery depends on nerve-sparing and baseline function; may take 6–24 months
- After radiation: ED develops gradually over 6–36 months
- During hormone therapy: ED is expected while on treatment; may recover after stopping
What you can do — Penile Rehabilitation (start early):
- PDE5 inhibitors (pills): Sildenafil (Viagra), tadalafil (Cialis) — your doctor may recommend daily low-dose tadalafil to promote blood flow even before erections return
- Vacuum erection device (VED / penis pump): Use daily for 10 minutes to maintain blood flow and penile health — even without sexual activity
- Penile injections (intracavernosal injections): Alprostadil or trimix — very effective; your doctor will teach you the technique
- Urethral suppository (MUSE): A small pellet inserted into the urethra
- Penile implant (prosthesis): A surgical option if other methods fail — high satisfaction rates
Lifestyle measures:
- Exercise regularly — cardiovascular health = sexual health
- Maintain a healthy weight
- Stop smoking
- Manage diabetes, blood pressure, and cholesterol
- Communicate openly with your partner
- Consider couples counseling or sex therapy
When to call your doctor:
- Painful erections or priapism (erection lasting more than 4 hours — emergency)
- No response to medications
- Emotional distress affecting your relationship or quality of life
Card G.4 — Bowel Side Effects
Most common after: Radiation therapy (EBRT, brachytherapy)
What to expect:
- Increased bowel frequency, urgency, loose stools, or mild rectal discomfort
- Usually begins 2–4 weeks into radiation
- Most symptoms resolve within 1–3 months after treatment
- Late effects (rectal bleeding, chronic changes) are uncommon with modern techniques and rectal spacers
What you can do:
- Dietary modifications:
- Eat smaller, more frequent meals
- Avoid high-fiber, greasy, spicy, or gas-producing foods during treatment
- Limit dairy if you notice worsening symptoms
- Bananas, rice, applesauce, toast (BRAT diet) can help with loose stools
- Gradually reintroduce normal diet after treatment ends
- Stay hydrated: Diarrhea can cause dehydration
- Over-the-counter medications: Loperamide (Imodium) for diarrhea — ask your doctor first
- Sitz baths: Warm water soaks for rectal discomfort
- Barrier creams: Protect skin around the anus if irritated
- Avoid straining: Use a stool softener if needed
When to call your doctor:
- More than 6 watery stools per day
- Blood in stool (more than a few drops)
- Severe abdominal cramping
- Diarrhea not controlled by medication
- Rectal bleeding months or years after treatment (late effect — needs evaluation)
Card G.5 — Hot Flashes
Most common after: Hormone therapy (ADT)
What to expect:
- Affect up to 80% of men on ADT
- Sudden feeling of intense warmth, flushing, and sweating
- Can last seconds to several minutes
- May occur multiple times per day, often worse at night
What you can do:
- Dress in layers — remove layers when a flash starts
- Keep your environment cool — fans, air conditioning, cool pillow
- Avoid triggers: Hot drinks, alcohol, spicy foods, hot showers, stress
- Exercise regularly — may reduce frequency and severity
- Deep breathing: Slow, deep breaths at the start of a flash can reduce intensity
- Cool water: Keep a cold drink or damp cloth nearby
Medical options (talk to your doctor):
- Venlafaxine (Effexor) — an antidepressant that reduces hot flashes
- Gabapentin — can help, especially with nighttime flashes
- Medroxyprogesterone or megestrol — hormonal options (discuss risks)
- Acupuncture — some evidence of benefit
Card G.6 — Fatigue
Most common after: Radiation therapy, hormone therapy, chemotherapy (all treatments)
What to expect:
- The most common side effect across all prostate cancer treatments
- During radiation: builds gradually, peaks near end of treatment, improves over weeks
- During hormone therapy: may persist as long as treatment continues
- During chemotherapy: often worst in the days after each cycle
What you can do:
- Exercise: The single most effective treatment for cancer-related fatigue
- Even 20–30 minutes of walking most days makes a significant difference
- Resistance training helps counteract muscle loss from hormone therapy
- Prioritize and pace: Plan important activities for your best-energy times
- Nap wisely: Short naps (20–30 minutes) are fine; avoid long daytime sleep
- Sleep hygiene: Keep a regular sleep schedule; dark, cool, quiet room
- Nutrition: Eat balanced meals; stay hydrated; avoid heavy meals before rest
- Accept help: Let family and friends assist with tasks
- Talk about it: Fatigue can cause frustration and low mood — this is normal
When to call your doctor:
- Fatigue so severe you cannot get out of bed or perform basic activities
- Sudden worsening of fatigue
- Fatigue accompanied by shortness of breath, dizziness, or rapid heartbeat (may indicate anemia)
Card G.7 — Bone Health and Fracture Prevention
Most common concern during: Long-term hormone therapy (ADT)
What to expect:
- ADT accelerates bone loss (osteoporosis), increasing fracture risk
- Bone density can decrease 2–5% per year on ADT
- Risk increases with duration of treatment
What you can do:
- Calcium: 1,000–1,200 mg daily (food sources preferred: dairy, fortified foods, leafy greens)
- Vitamin D: 1,000–2,000 IU daily (your doctor will check your blood level)
- Weight-bearing exercise: Walking, jogging, stair climbing, dancing
- Resistance training: Strengthens muscles and bones
- Fall prevention: Remove tripping hazards at home; wear supportive shoes; consider balance exercises
- Avoid smoking and excessive alcohol
Medical monitoring and treatment:
- DEXA scan (bone density test) at baseline and periodically during ADT
- Bisphosphonates (e.g., zoledronic acid) or denosumab (Xgeva/Prolia) if bone density is low
- Report any new back pain, hip pain, or loss of height to your doctor
Card G.8 — Cardiovascular and Metabolic Health on ADT
Most common concern during: Hormone therapy (ADT)
What to expect:
- ADT can increase risk of weight gain, high blood sugar, high cholesterol, and cardiovascular events
- These risks increase with longer duration of treatment
What you can do:
- Exercise regularly: At least 150 minutes per week of moderate activity
- Heart-healthy diet: Mediterranean-style eating; limit processed foods, sugar, and saturated fat
- Monitor your weight: Weigh yourself weekly; report gains of more than 5 pounds
- Know your numbers: Blood pressure, blood sugar (HbA1c), cholesterol (lipid panel)
Medical monitoring:
- Baseline cardiovascular risk assessment before starting ADT
- Regular blood pressure, glucose, and lipid checks
- Cardiology referral if pre-existing heart disease
- Discuss oral GnRH antagonist (relugolix) with your doctor if cardiovascular risk is high — may have a better cardiac safety profile
Card G.9 — Emotional and Psychological Well-Being
Relevant to: All stages of prostate cancer
What to expect:
- Anxiety, depression, fear of recurrence, grief, anger, and frustration are all normal
- Hormone therapy can worsen mood changes
- Diagnosis and treatment can affect relationships and self-image
What you can do:
- Talk about it: Share your feelings with a trusted person — partner, friend, family member, counselor
- Join a support group: Hearing from other men who understand can be powerful (see Appendix H)
- Stay active: Exercise is one of the best treatments for anxiety and depression
- Maintain routines: Structure and normalcy help
- Limit "Dr. Google": Stick to trusted sources (see Appendix H)
- Mindfulness and relaxation: Deep breathing, meditation, yoga — even 10 minutes daily helps
- Professional help: A psychologist, psychiatrist, or social worker experienced in cancer care can make a significant difference
When to seek help immediately:
- Thoughts of self-harm or suicide — call 988 (Suicide and Crisis Lifeline) or go to the nearest emergency room
- Inability to eat, sleep, or function for more than 2 weeks
- Withdrawal from all activities and relationships
- Substance use to cope
Card G.10 — Chemotherapy Side Effects
Most common during: Docetaxel or cabazitaxel treatment
What to expect:
- Side effects vary by drug and by person
- Most side effects are temporary and manageable
- Your oncology team will monitor you closely
Common side effects and what to do:
| Side Effect | What to Do |
|---|---|
| Nausea | Take anti-nausea medications as prescribed; eat small, bland meals; ginger tea may help |
| Fatigue | Rest when needed; light exercise on good days; see Card G.6 |
| Low blood counts | Avoid sick contacts; wash hands frequently; report fever > 100.4°F immediately |
| Neuropathy (tingling/numbness in hands/feet) | Report early; dose adjustments may be needed; avoid extreme temperatures |
| Hair thinning | Usually mild with docetaxel; hair regrows after treatment |
| Mouth sores | Gentle oral care; soft toothbrush; salt water rinses; avoid spicy/acidic foods |
| Diarrhea | See Card G.4; stay hydrated; call if > 6 episodes/day |
| Nail changes | Keep nails short; wear gloves for cleaning; ice hands/feet during infusion may help |
| Fluid retention / swelling | Elevate legs; report sudden weight gain or shortness of breath |
| Taste changes | Try different foods; use plastic utensils if metallic taste; season foods differently |
Emergency — call your doctor or go to the ER:
- Fever ≥ 100.4°F (38°C) — this is an emergency during chemotherapy
- Uncontrolled vomiting or diarrhea
- Unusual bleeding or bruising
- Severe shortness of breath
- Confusion