Published on October 12, 2015
What are the common side effects of advanced prostate cancer treatment, and how can they be managed? An expert panel—including Dr. Jeri Kim, Dr. Sumit Subudhi and Zita Dubauskas Lim—shares an overview of side effects associated with hormonal therapies, chemotherapy and immunotherapy.
Sponsored by the Patient Empowerment Network through an educational grant from Sanofi and an independent educational grant from Astellas and Medivation, Inc. Produced in association with The University of Texas MD Anderson Cancer Center.
Transcript | An Overview of Prostate Cancer Treatment Side Effects
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So we need to create kind of two buckets, if you will, of symptoms. There [are] the symptoms that are caused by the disease. And those symptoms are managed by the treatment protocols. But there [are] also the symptoms, the reactions from the treatment itself. And maybe we can even call it the fear of those symptoms and reactions keeps some people from actually pursuing their one treatment plan.
Zita, talk a little bit about that difference and what patients should be looking for as far as reactions to treatment.
Zita Dubauskas Lim:
Okay. So I just want to harken back to that idea that every treatment that we offer is gonna have a host of side effects. And I just want to encourage everybody not to get discouraged or frightened by the consent process and reading the list of side effects.
Because I kind of jokingly say we’re bound by the FDA and just rules of disclosure to list every possible side effect, knowing that you’re probably not gonna experience that. But it’s there, and it’s listed. So I just—first of all, I want you to not get discouraged and say, “Oh, I’m expecting this and this and this and this.” You may not have any of those side effects. You may have several of them.
But then the question becomes, I think, of discerning what is the side effect from the cancer itself versus the side effect of the treatment. I would say, when I’ve—in my experience, just that patients who come to us with a significant burden of side effects already from the cancer at the get-go usually notice an improvement after treatment so patients who come to you in urinary retention.
Patients who come to you—like that? Okay, I’m sorry. Who already come to you with significant pain, once they start treatment, they will actually feel better. Their fatiguement will improve. Their pain will hopefully improve. On the flip side, if you’re somebody who was diagnosed, but really, if it wasn’t for the scans or the reports, you wouldn’t know that you have the cancer, yes, you may end up having actually potentially more side effects than initially at this time point than you would without any treatment.
But the concern is, is that that time—that disease-free period or side effect-free period may not last a long time, and so that’s why your doctor is recommending treatment at that time, because they know about the potential about this disease left untreated. So—and again, the side effects, again, are very different from the specific treatments.
At some point with prostate cancer, everyone’s gonna need treatment. What do we get to look forward to with these treatment side effects?
Start with you, Dr. Subudhi, and we’re gonna go right down the line. Hopefully, we get the 50,000-foot view, and then we get the nuts and bolts of what’s really happening on the ground.
Yeah. So I think that just about every single treatment of prostate cancer does cause some level of fatigue, and that level varies from patient to patient, and we can’t predict who’s gonna get more of it or less.
When it comes to the immunotherapies, I’ll talk about more, and you can talk more about the hormonal therapies. But the immunotherapies that Zita alluded to, when we’re boosting your immune system, we’re not smart enough yet as scientists or doctors to teach your immune system to only attack the cancer. So one of the challenges with the immunotherapies, and one of the major side effects, is that the cancer—sorry, that your immune cells may actually attack other organs in your body.
And that includes any organ. That can include your eyes, where you can be transiently blind. It can include your skin, where you get a rash. It can include your intestines, where you’ll have life-threatening diarrhea, or colitis, as it’s called. It can attack your lungs, where you can actually die from pneumonitis. So any organ in your body is fair game. The whole point with the immunotherapies and what Zita’s alluding to, and many of you patients that have gone to the prostate cancer trials with me, you get my email, cell phone, home phone number.
The reason for it is because I know how to reverse it quickly. You don’t necessarily have to even come to MD Anderson. You can go to your local doctor. As long as they talk to me, I know what to tell them what to do to reverse many of these side effects. But the key point is to have us know about them sooner than later. As a joke to my patient, I say, “I want to know when you fart wrong,” okay?
Common treatment side effects. So we’re talking about immunotherapy agents here. They’re generally things that the body’s never seen before. So I get my first injection or swallow a pill of this new-fangled stuff, and I start getting spots all over me. What’s happening? What’s going on?
So we talked about common treatment side effects and treatment-dependent side effects.
So you’re talking about rash. I mean, rash can be due to allergic reaction to a drug. It can be due to just the drug itself causing a rash. So there are obviously different causes for having a rash. So you should definitely call your doctor or call Zita to see what’s going on. And so always communicate with your management team. So that’s very important.
And so just mentioning treatment-dependent side effects. So for patients getting treatment with hormonal therapy, we talked about different side effects, fatigue being a common side effect, bone density loss, a loss of libido, and erectile dysfunction and so forth. Treatment-dependent side effects of chemotherapy, it can affect your bone marrow, so you can have low white cell count, low platelet count, anemia.
It can cause some nausea and occasionally vomiting. But the good thing is that we have now good medications or supportive medications to manage these side effects. So always talk to your doctor and talk to your nurse practitioner who’s taking care of you, so.