Prostate Cancer Need-to-Know

The Prostate Cancer Need-to-Know blog post is PeopleBeatingCancer.org’s Pillar Post for Prostate Cancer (PCa). As a long-term cancer survivor myself, my purpose in creating and managing PeopleBeatingCancer is to address my lament, “I wish I knew then what I know now.” The more that newly diagnosed cancer patients know about their cancer diagnosis, the better their decision-making will be.

What are the most important things for newly diagnosed prostate cancer patients to know?

The basics-

Prostate cancer is the second-most frequently diagnosed cancer in men, and the second-most frequent cause of cancer death in men (after lung cancer).^[2]^[3]Around 1.2 million new cases of prostate cancer are diagnosed each year, and more than 350,000 people die of the disease annually.^[2] One in eight men are diagnosed with prostate cancer in their lifetime, and around one in forty die of the disease.^[3]

When I asked ChatGPT what the 10 most important things to know about PCa were, it spit out the list below. Your oncologist/urologist would consider that list to be:

Diagnosis/Risk
Treatment Plans
Side Effects

While I believe this list is good, I would emphasize the evidence-based non-conventional side of PCa more by highlighting:

Prehabilitation, regardless of your treatment plan, has been shown to enhance treatment efficacy while reducing side effects.
Diet and gut microbiome–

1. Prostate cancer is often slow-growing

Many prostate cancers—especially low-risk disease—grow very slowly and may never cause symptoms or shorten life. This means there is often time to make thoughtful decisions, seek second opinions, and avoid rushing into treatment.

2. Not all prostate cancers need immediate treatment

For men with low-risk disease, active surveillance (regular PSA tests, imaging, and biopsies) is a widely accepted approach that avoids treatment side effects while maintaining excellent survival outcomes.

3. Risk category matters more than PSA alone

Treatment decisions are based on a combination of:

PSA level
Gleason score / Grade Group
Cancer stage
MRI findings
Number of biopsy cores involved

Two men with the same PSA can have very different risks and treatment needs.

4. Side effects vary widely by treatment

Common treatments (surgery, radiation, hormone therapy) can affect:

Urinary control
Sexual function
Bowel function
Energy and mood

Understanding both short- and long-term effects is as important as understanding cure rates.

5. Surgery and radiation have similar survival for many patients

For localized prostate cancer, long-term survival is often comparable between surgery and radiation. The choice often comes down to side-effect profiles, age, anatomy, and personal priorities.

6. Hormone therapy has systemic effects

lAndrogen deprivation therapy (ADT)lowers testosterone and can cause:

Fatigue
Weight gain and muscle loss
Hot flashes
Bone thinning
Cardiovascular and metabolic effects

These risks should be discussed carefully—especially for men with heart disease or diabetes.

7. Second opinions are strongly encouraged

Prostate cancer management is nuanced. A second opinion from:

Another urologist
A radiation oncologist
A medical oncologist

often changes or refines treatment recommendations.

8. New imaging and genomic tools can refine decisions

Modern tools such as:

Multiparametric prostate MRI
PSMA PET scans (in certain settings)
Genomic tests (e.g., Decipher, Oncotype DX, Prolaris)

can help better predict aggressiveness and guide treatment intensity.

9. Lifestyle choices can influence outcomes

Evidence supports benefits from:

Regular physical activity
Heart-healthy, plant-forward diets
Maintaining muscle mass during treatment
Managing stress and sleep

These steps can reduce treatment side effects and improve quality of life.

10. You are not alone—and support matters

Emotional, sexual, and identity-related impacts are common but often under-discussed. Support can come from:

Support groups
Mental health professionals
Sexual health specialists
Partners and caregivers
Bruce Nevin- Prostate Cancer Survivor

Quality of life deserves as much attention as cancer control.

A “what to ask your doctor” checklist
A decision comparison table (surgery vs radiation vs surveillance)
A time-burden guide
Guidance tailored to low-, intermediate-, or high-risk disease

And finally, you can talk to a long-term cancer survivor aka me. My cancer, multiple myeloma, is very different from prostate cancer, but you’d be surprised to find out how many issues we have in common. For example:

While oncology is important, they are only a small piece of the PCa puzzle. Conventional medical doctors are not educated about nutrition, supplements, or lifestyle therapies. Don’t be surprised if your doctor knows little about these topics.
Conventional oncology focuses on PCa treatment. My focus is on surviving prostate cancer. Your job is to figure out what your priorities are. Cancer patients often have to decide between length of life and quality of life.
Lastly, I am a cancer coach. Feel free to reach out with a question or comment. Scroll down the page and write me a post. I will reply to you ASAP.

David Emerson

Cancer Survivor
Cancer Coach
Director PeopleBeatingCancer

As a long-term survivor (different cancer), I have spent the past 35 or so years struggling with my short-term, long-term and late-stage side effects. Many of which overlap with long-term PCa survivors.

By learning about the most common side effects of PCa therapies, you can limit, prevent or heal your therapy-related side effects.

Prostate cancer treatment side effects depend a lot on which treatment (or combination) is used and the person’s baseline health. That said, there are some very common, predictable patterns. Here’s a clear, practical overview—organized by treatment type.

1. Surgery (Radical Prostatectomy)

Most common

Urinary incontinence (leakage, stress incontinence)
Erectile dysfunction (very common early; recovery varies)
Loss of ejaculation (orgasm without semen)

Other possible effects

Short-term pain and fatigue
Bladder irritation or urgency
Penile shortening (small but real effect in some men)

👉 Incontinence often improves over months; sexual function recovery may take 1–2 years and depends on nerve sparing, age, and baseline function.

2. Radiation Therapy

(External beam radiation or brachytherapy)

Urinary

Frequency, urgency
Burning with urination
Weak stream or difficulty emptying

Bowel

Diarrhea
Rectal urgency
Rectal bleeding (usually delayed)

Sexual

Gradual erectile dysfunction (often develops months–years later)

General

Fatigue (especially during treatment)

👉 Radiation side effects tend to appear gradually, unlike surgery’s immediate effects.

3. Androgen Deprivation Therapy (ADT / Hormone Therapy)

Very common

Hot flashes
Loss of libido
Erectile dysfunction
Fatigue

Metabolic & body changes

Weight gain
Loss of muscle mass
Increased body fat
Gynecomastia (breast enlargement/tenderness)

Bone & cardiovascular

Bone thinning (osteoporosis)
Increased risk of diabetes and cardiovascular disease

Mood & cognition

Depression
Brain fog or memory changes
Sleep disturbance

👉 ADT often has the widest systemic effects, especially when used long-term.

4. Chemotherapy (less common, advanced disease)

Fatigue
Hair thinning or loss
Neuropathy (numbness/tingling)
Low blood counts (infection risk)
Nausea (usually well controlled now)

5. Newer / Targeted Therapies

(e.g., androgen-receptor inhibitors, radiopharmaceuticals)

Fatigue
Hypertension
Falls/fractures
Cognitive slowing
GI symptoms (nausea, constipation)

Side effects vary widely depending on the specific drug.

Big Picture Takeaways

Sexual dysfunction and urinary changes are the most common across treatments
Hormone therapy causes the most whole-body effects
Many side effects are treatable and improve over time
Early pelvic floor therapy, exercise, and symptom-targeted meds make a real difference

Prostate Cancer Need-to-Know Prostate Cancer Need-to-Know Prostate Cancer Need-to-Know