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Understanding
Prostate Cancer

Prostate cancer is marked by an uncontrolled growth of cells in the prostate gland.71 It is one of the top three cancers in men worldwide and in Hong Kong.72, 73

FACTS OF 201973

* SOURCE: HONG KONG CANCER REGISTRY

* SOURCE: HONG KONG CANCER REGISTRY

Signs and symptoms

The prostate is a gland of the male reproductive system. It is about the size and shape of a walnut, siting low in the pelvis, below the bladder and just in front of the rectum. The primary function of the prostate is to help make semen – the fluid that carries sperm.74
Prostate cancer tends to grow slowly compared with most other cancers.74 Early prostate cancer usually causes no symptoms; by the time symptoms appear, the cancer may already be advanced.74
Signs and symptoms of prostate cancer may include: 74

  1. Difficulty when passing urine
  2. Frequent urination, especially at night
  3. Weak or interrupted urine stream
  4. Blood in urine or semen
  5. Pain with ejaculation
  6. Pain in the back, hips, or pelvis

In advanced stages, prostate cancer tends to spread to the bones, so it often causes bone pain, especially in the back.74

Causes and risk factors

Researchers do not know exactly what causes prostate cancer. However, they have found several factors that might affect a man’s risk of getting prostate cancer.
Risk factors for prostate cancer may include: 75

  • Age

    Men who are 50 or older have a higher risk of developing prostate cancer.

  • Race

    Men of African origin have a higher risk of prostate cancer than in man of other races.

  • Family history

    Men whose fathers or brothers have had prostate cancer are at higher risk of getting the disease.

  • Gene changes

    People with inherited mutations of the BRCA1 or BRCA2 genes are more likely to have prostate cancer.

BRCA gene mutations and prostate cancer

Inherited mutations of the BRCA1 or BRCA2 genes, which are linked to an increased risk of breast and ovarian cancers in some families, can also increase prostate cancer risk in men, especially mutations in BRCA2.75

Men who have a BRCA2 gene mutation have a higher lifetime risk of developing prostate cancer.76 Approximately 20-25% of men who have a BRCA2 mutation develop prostate cancer at some point during their lives, often over the age of 45.76

Therefore, men who have a family history of breast, ovarian or prostate cancer should talk with their doctor about whether genetic tests should be considered.

In addition, men diagnosed with prostate cancer who also have a BRCA mutation are more likely to have an aggressive form of the disease and a higher mortality rate.77 It is estimated that approximately 12% of men with advanced prostate cancer have a BRCA mutation.78

As a result, doctors may recommend that men with prostate cancer take tests to identify whether they have a BRCA mutation, which may help doctors assess the prognosis of the disease and evaluate treatment options.

  • ABOUT 20-25% MEN
    who inherit a BRCA2 mutation will develop prostate cancer during their lifetime, often over the age of 45 years76
  • ABOUT 12% MEN
    with advanced prostate cancer have a BRCA mutation.78

Diagnosis

01

If prostate cancer is suspected, following tests may be used to decide if more diagnostic tests are needed:

  • Digital rectal examination (DRE):79 A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and examines the prostate to find any abnormalities in the texture, shape, or size of the gland.
  • Prostate specific antigen (PSA) blood test:79 PSA is a protein produced by the prostate cells. If the PSA level is found higher than usual in the blood, it may indicate prostate inflammation, enlargement, or cancer.
    • Most men without prostate cancer have blood PSA levels under 4 ng/mL. Still, a level below 4 is not a guarantee that a man does not have cancer.80
    • Men with a PSA level between 4 and 10 ng/mL have about a 1 in 4 chance of having prostate cancer.80
    • If the PSA is more than 10 ng/mL, the chance of having prostate cancer is over 50%.80
  • Free PSA test:79 Free PSA is a form of PSA found in the bloodstream that is not bound to proteins. A standard PSA test measures total PSA, which includes both PSA that is and is not bound to proteins. The free PSA test measures the ratio of free PSA to total PSA. Knowing this ratio can sometimes help find out if an elevated PSA level is more likely to be caused by a malignant condition such as prostate cancer.

02

If the PSA or DRE test results are abnormal, then further tests will be used to confirm whether a person has prostate cancer. Many other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis.79

  • Prostate biopsy:79 A prostate biopsy is the removal of tiny samples of prostate tissue to examine it under a microscope for signs of prostate cancer. To get a tissue sample, a doctor often uses transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI), or a ‘fusion’ of the two, and a biopsy tool to take very small pieces of prostate tissue. Biopsy specimens will be taken from several areas of the prostate, ensuring that a good sample is taken for examination. Most people will have 12 to 14 pieces of tissue removed, and the procedure takes 20 to 30 minutes to complete.
  • MRI fusion biopsy:79 It is a biopsy procedure that combines an MRI scan with TRUS. During the procedure, pictures from MRI and ultrasound scans are combined to create a detailed 3D image of the prostate, helping doctors precisely target the area of the prostate that needs to be biopsied. This approach can better identify areas that are more likely to be cancerous than other methods.
  • Transrectal ultrasound (TRUS):79 A doctor inserts a probe into the rectum that takes a picture of the prostate using sound waves that bounce off the prostate. A TRUS is usually done at the same time as a biopsy.

03

If a biopsy confirms the presence of cancer, then it needs to determine the level of aggressiveness (grade) of the cancer cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly.80 Techniques used to determine the aggressiveness of the cancer include:

  • Gleason score:80 This is the most common scale used to evaluate the grade of prostate cancer cells. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer). The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7.
    • A score of 6 or less indicates a low-grade prostate cancer.
    • A score of 7 indicates an intermediate-grade prostate cancer.
    • Scores from 8 to10 indicate high-grade prostate cancer.
  • Grade groups:80 In recent years, doctors have realized that the Gleason score might not always be the best way to grade prostate cancer. For instance, not all cancers with a Gleason score of 7 are the same. Patients with a Gleason score 3+4=7 cancer tend to do better than those with a 4+3=7 cancer. Therefore, doctors have developed Grade Groups, ranging from 1 (most likely to grow and spread slowly) to 5 (most likely to grow and spread quickly):
    • Grade Group 1 = Gleason 6 (or less)
    • Grade Group 2 = Gleason 3+4=7
    • Grade Group 3 = Gleason 4+3=7
    • Grade Group 4 = Gleason 8
    • Grade Group 5 = Gleason 9-10
    If a biopsy report shows a man has prostate cancer, it might show both the Gleason score and the grade group.
  • Genetic testing:80 Genetic testing helps doctors to find out whether a prostate cancer patient carries certain inherited gene changes, such as a BRCA gene mutation. This type of test provides more information for making treatment decisions in certain situations.

04

If it is suspected that the prostate cancer has spread, one or more of the following imaging tests may be recommended:79

  • Bone scan
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scan

Prostate cancer staging

Staging is used to determine the extent of the cancer. Prostate cancer staging is vital because it is used to guide the treatment plan and to assess patient prognosis. The stage of the prostate cancer is based on the results of the staging and diagnostic tests, including the PSA level and the Grade Group.81

Stage I81, 82

The tumor is contained in the prostate. It is too small to be felt when a doctor does a DRE. PSA levels are low (less than 10 ng/mL). The cancer cells look like healthy cells. Cancer in this early stage is usually slow growing.

Stage II81, 82

The tumor is still contained in the prostate, but doctors may or may not feel it when they do a DRE. PSA levels are medium or low (less than 20 ng/mL). Stage II prostate cancer is small but may have an increasing risk of growing and spreading. Depending on the extent of the cancer, stage II is divided into stages IIA, IIB, and IIC.

Stage III81, 82

The tumor has started to break through the outer layer of the prostate and may spread into nearby tissues, seminal vesicles, and nearby structures such as the bladder or rectum. PSA levels are high (more than 20 ng/mL), or the cancer is high grade. These all indicate a locally advanced cancer that is likely to grow and spread. Stage III is divided into stages IIIA, IIIB, and IIIC depending on the extent of the cancer.

Stage IV81, 82

The cancer has spread beyond the prostate to the regional lymph nodes, distant lymph nodes, other parts of the body, or the bones.The PSA can be any value. Depending on the extent of the cancer, stage IV is divided into stages IVA and IVB.

Recurrent81

Recurrent prostate cancer is the cancer that has come back after treatment. The cancer may come back in the prostate area again or in other parts of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence.

Active surveillance or observation
Surgery
Radiotherapy
Cryotherapy
Hormone therapy
Chemotherapy
Targeted therapy
Immunotherapy
Treatments for prostate cancer spread to bones

Treatment options

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Patients should discuss with their doctor to decide on the most appropriate treatment for them.

Active surveillance or observation

Active surveillance and observation (also called watchful waiting) are treatments used for prostate cancer patients who are older, do not have symptoms, or have other serious medical conditions.84

1A
Active surveillance84
In active surveillance, a patient's condition is closely monitored without giving any treatment unless there are changes in test results. Usually this includes PSA blood test about every 6 months, a DRE once a year, and prostate biopsies and imaging tests every 1-3 years.
1B
Observation (watchful waiting)84
This is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a patient’s symptoms to decide if treatment is needed.

Active surveillance or observation

Active surveillance and observation (also called watchful waiting) are treatments used for prostate cancer patients who are older, do not have symptoms, or have other serious medical conditions.84

1A
Active surveillance84
In active surveillance, a patient's condition is closely monitored without giving any treatment unless there are changes in test results. Usually this includes PSA blood test about every 6 months, a DRE once a year, and prostate biopsies and imaging tests every 1-3 years.
1B
Observation (watchful waiting)84
This is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a patient’s symptoms to decide if treatment is needed.
Surgery

Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor.85

Types of surgery may include:

1A
Radical prostatectomy85
A surgical procedure to remove the entire prostate, some of the surrounding tissue, including the seminal vesicles (a gland that helps make semen). Nearby lymph nodes may also be removed at the same time. The main types of radical prostatectomy include open radical prostatectomy, radical laparoscopic prostatectomy, and robot-assisted laparoscopic radical prostatectomy.
1B
Pelvic lymphadenectomy85
A surgical procedure to remove the lymph nodes in the pelvis for examination under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.
1C
Transurethral resection of the prostate (TURP)85
A surgical procedure to remove tissue from the prostate using a resectoscope inserted through the urethra. This procedure is more often used to treat benign prostatic hypertrophy and it is sometimes used to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may also be used in patients whose tumor is in the prostate only and who cannot have a radical prostatectomy.

Surgery

Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor.85

Types of surgery may include:

1A
Radical prostatectomy85
A surgical procedure to remove the entire prostate, some of the surrounding tissue, including the seminal vesicles (a gland that helps make semen). Nearby lymph nodes may also be removed at the same time. The main types of radical prostatectomy include open radical prostatectomy, radical laparoscopic prostatectomy, and robot-assisted laparoscopic radical prostatectomy.
1B
Pelvic lymphadenectomy85
A surgical procedure to remove the lymph nodes in the pelvis for examination under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment.
1C
Transurethral resection of the prostate (TURP)85
A surgical procedure to remove tissue from the prostate using a resectoscope inserted through the urethra. This procedure is more often used to treat benign prostatic hypertrophy and it is sometimes used to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may also be used in patients whose tumor is in the prostate only and who cannot have a radical prostatectomy.
Radiotherapy

Radiotherapy involves using radiation to kill cancer cells. The main types of radiotherapy used for prostate cancer include external beam radiotherapy and brachytherapy (internal radiotherapy).86

1A
External beam radiotherapy (EBRT)86
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiotherapy is an option for treating early-stage prostate cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
1B
Brachytherapy (internal radiotherapy)86
Brachytherapy involves placing radioactive substance directly into the prostate. It is generally used only in patients with early-stage prostate cancer that is relatively slow growing.

Radiotherapy

Radiotherapy involves using radiation to kill cancer cells. The main types of radiotherapy used for prostate cancer include external beam radiotherapy and brachytherapy (internal radiotherapy).86

1A
External beam radiotherapy (EBRT)86
In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiotherapy is an option for treating early-stage prostate cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.
1B
Brachytherapy (internal radiotherapy)86
Brachytherapy involves placing radioactive substance directly into the prostate. It is generally used only in patients with early-stage prostate cancer that is relatively slow growing.
Cryotherapy

Cryotherapy or cryoablation for prostate cancer involves using a very cold gas to freeze the prostate tissue and kill prostate cancer cells.87 It is done with transrectal ultrasound to guide several hollow probes through the skin between the anus and scrotum and into the prostate, and very cold gases are then passed through the needles to freeze the prostate. 87

Cryotherapy can be used when the prostate cancer has returned after radiotherapy, and might also be used to treat men with low risk early-stage prostate cancer who cannot have surgery or radiotherapy.87

Cryotherapy

Cryotherapy or cryoablation for prostate cancer involves using a very cold gas to freeze the prostate tissue and kill prostate cancer cells.87 It is done with transrectal ultrasound to guide several hollow probes through the skin between the anus and scrotum and into the prostate, and very cold gases are then passed through the needles to freeze the prostate. 87

Cryotherapy can be used when the prostate cancer has returned after radiotherapy, and might also be used to treat men with low risk early-stage prostate cancer who cannot have surgery or radiotherapy.87

Hormone therapy

Hormone therapy for prostate cancer is a treatment to stop the body from producing male sex hormones which is called androgens. 88 The most common androgen is testosterone.

Because prostate cancer cells rely on androgens to help them grow, lowering levels of these hormones can help make prostate cancers shrink or grow more slowly.88

Several types of hormone therapy can be used to treat prostate cancer:

1A
Medications
Drugs used to lower the levels of androgens include those that:85
  • Prevent prostate cancer cells from making androgens
  • Prevent the testicles from making androgens
  • Stop the testicles from making androgens
  • Block the action of androgens
  • Prevent the adrenal glands from making androgens
1B
Surgery to remove the testicles (orchiectomy)
Removing the testicles reduces androgens levels in the body quickly and significantly, causing most prostate cancers to stop growing or shrink for a time.88 But unlike medication options, surgery to remove the testicles is permanent and irreversible.

Hormone therapy

Hormone therapy for prostate cancer is a treatment to stop the body from producing male sex hormones which is called androgens. 88 The most common androgen is testosterone.

Because prostate cancer cells rely on androgens to help them grow, lowering levels of these hormones can help make prostate cancers shrink or grow more slowly.88

Several types of hormone therapy can be used to treat prostate cancer:

1A
Medications
Drugs used to lower the levels of androgens include those that:85
  • Prevent prostate cancer cells from making androgens
  • Prevent the testicles from making androgens
  • Stop the testicles from making androgens
  • Block the action of androgens
  • Prevent the adrenal glands from making androgens
1B
Surgery to remove the testicles (orchiectomy)
Removing the testicles reduces androgens levels in the body quickly and significantly, causing most prostate cancers to stop growing or shrink for a time.88 But unlike medication options, surgery to remove the testicles is permanent and irreversible.
Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing, dividing, and making more cells.89 It can be taken by mouth or injected into a vein or muscle. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time.

Chemotherapy may be a treatment option for treating those with advanced or castration-resistant prostate cancer and those with newly diagnosed or castration-sensitive metastatic prostate cancer.89 Castration-resistant prostate cancer is a form of prostate cancer that keeps growing even when the amount of testosterone in the body is reduced to very low levels, and castration-sensitive prostate cancer is a form of prostate cancer that responds to treatments that lower testosterone levels.

There are several standard chemotherapy drugs used for prostate cancer. Patients should discuss with their doctor to decide the most appropriate treatment for them.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing, dividing, and making more cells.89 It can be taken by mouth or injected into a vein or muscle. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time.

Chemotherapy may be a treatment option for treating those with advanced or castration-resistant prostate cancer and those with newly diagnosed or castration-sensitive metastatic prostate cancer.89 Castration-resistant prostate cancer is a form of prostate cancer that keeps growing even when the amount of testosterone in the body is reduced to very low levels, and castration-sensitive prostate cancer is a form of prostate cancer that responds to treatments that lower testosterone levels.

There are several standard chemotherapy drugs used for prostate cancer. Patients should discuss with their doctor to decide the most appropriate treatment for them.

Targeted therapy

Targeted therapy is a type of drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.89

Targeted therapy blocks the growth and spread of cancer cells and limits damage to healthy cells; it may be recommended to treat metastatic castration-resistant prostate cancer.89

Some targeted therapies only work in people whose cancer cells have certain genetic mutations, such as BRCA1 and BRCA2 mutations89. To find the most effective treatment, some doctors may advise their prostate cancer patients to take tests to identify the genes, proteins, and other factors in their tumor cells. This helps doctors better match each patient with the most effective treatment whenever possible.89

Targeted therapy

Targeted therapy is a type of drug treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.89

Targeted therapy blocks the growth and spread of cancer cells and limits damage to healthy cells; it may be recommended to treat metastatic castration-resistant prostate cancer.89

Some targeted therapies only work in people whose cancer cells have certain genetic mutations, such as BRCA1 and BRCA2 mutations89. To find the most effective treatment, some doctors may advise their prostate cancer patients to take tests to identify the genes, proteins, and other factors in their tumor cells. This helps doctors better match each patient with the most effective treatment whenever possible.89

Immunotherapy

Immunotherapy is a type of treatment to boost the patient’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.89

Immunotherapy may be an option for some people with metastatic castration-resistant prostate cancer who have no or very few cancer symptoms and generally have not had chemotherapy.89

Immunotherapy

Immunotherapy is a type of treatment to boost the patient’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.89

Immunotherapy may be an option for some people with metastatic castration-resistant prostate cancer who have no or very few cancer symptoms and generally have not had chemotherapy.89

Treatments for prostate cancer spread to bones

When prostate cancer spreads, the bones are typically the first area affected.90 Bone metastasis can cause severe pain and other problems, such as fractures, spinal cord compression, or high blood calcium levels, which can be dangerous or even life threatening.90

Treatments such as hormone therapy, chemotherapy, and immunotherapy may be used to help with this; radiotherapy can also be used to control bone pain and to help relieve pressure on the spinal cord; other treatments specifically target bone metastasis and the problems it may cause can also be used to help relieve pain and high calcium levels, and to help delay or prevent fractures.90

Treatments for prostate cancer spread to bones

When prostate cancer spreads, the bones are typically the first area affected.90 Bone metastasis can cause severe pain and other problems, such as fractures, spinal cord compression, or high blood calcium levels, which can be dangerous or even life threatening.90

Treatments such as hormone therapy, chemotherapy, and immunotherapy may be used to help with this; radiotherapy can also be used to control bone pain and to help relieve pressure on the spinal cord; other treatments specifically target bone metastasis and the problems it may cause can also be used to help relieve pain and high calcium levels, and to help delay or prevent fractures.90

01
I am receiving prostate cancer treatment, what should I pay attention to in my daily care?
Cancer can cause physical and emotional strain, so prostate cancer patients should look after their wellbeing during and after the treatment.

General recommendations may include:

  • Eating well:91 Healthy food can help people with prostate cancer cope with treatment and side effects. Patients should talk with their doctor or consult with a dietitian to learn more about how to manage any special dietary needs and choose the best foods for their situation.
  • Staying active:91 Physical activity can reduce tiredness, improve circulation, and lift mood. The right exercise for a prostate cancer patient depends on many factors, such as what treatment is being used, how the patient feels, and what is his general health condition. Patients should talk with their doctor to help them develop an exercise plan.
  • Complementary therapies:91 Complementary therapies are designed to be used alongside conventional medical treatments. Therapies such as massage and relaxation can increase a person’s sense of control, decrease stress and anxiety, and improve mood. Patients should talk with their doctor about any therapies they are using or thinking about trying, as some may not be safe, or evidence based.
02
My prostate cancer treatment is completed, what follow-up care should I take?
A cancer patient’s follow-up care may include regular physical examinations and medical tests to keep track of the recovery in the months and years ahead. Different people have different risks, so prostate cancer patients should talk with their doctor about how their risk affect their schedule of follow-up care.

Main follow-up care may include:

  • Watching for cancer recurrence:92 Sometimes prostate cancer does come back after treatment. During follow-up care, a doctor will ask specific questions about the patient’s health. Blood tests or imaging tests may sometimes be recommended as part of regular follow-up care, but testing recommendations depend on several factors, such as the type and stage of cancer first diagnosed, and the types of treatment given.
  • Managing long-term and late side effects:92 Some patients may experience side effects that linger beyond the treatment period, which are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes. Talk with your doctor about your risk of developing late effects. Patients should talk with their doctor about their risk of developing late effects.
03
I am a prostate cancer patient. Why would my doctor suggest a BRCA test?
Because a number of prostate cancer patients have inherited BRCA1 or BRCA2 gene mutations95, taking BRCA tests may help your doctor decide a personalized treatment based on the test results. For prostate cancer patients, genetic testing not only opens up drug options and improves the effectiveness of the treatment, but it can also provide useful information to the patient's family on the risk of developing cancer if inherited BRCA mutations are found.
04
Is the BRCA testing an internationally recognized procedure?
Many guidelines on BRCA testing are available worldwide. In the United States, the US National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO) and the US Preventive Services Task Force (USPSTF) have published policy statements for genetic testing for BRCA-related cancer.93 The recently updated recommendations from ASCO include a strong endorsement to perform genetic testing of all men with metastatic prostate cancer to inform precision medicine eligibility.94 BRCA1 and BRCA2 are one of the priority genes to be tested for metastatic disease treatment94. Importantly, people should have genetic counselling before taking germline BRCA tests.
05
What is Genetic Counselling?
Before any genetic test is done, doctors and nurses with specialized training or genetic counseling specialists will carry out genetic counseling with the patients. This is to explain the testing procedures, risks, and clinical significance of different test results, and to discuss the impact of the result on the patients and their family, including emotional effects, parenting and birth control, screening, and decisions on treatment96,97. After the genetic counseling, patients will decide whether they would want to receive the genetic test.

(Note: Hong Kong Academy of Medicine would like to remind the public, any genetic test without appropriate advice, counseling and data analysis may lead to additional medical risk and inaccurate test results, and the lack of professional interpretation and advice may also cause unnecessary anxiety or a false sense of safety.)98

FAQ

For caregivers

If you are a caregiver to take care of a prostate cancer patient, you are playing an important role! You are the one taking care of the patient’s daily and medical care during and after the treatment. But do not forget to look after yourself, as you must be strong enough to go through this journey with the patient. The following suggestions may help you as a caregiver:

Understand prostate cancer

Understand prostate cancer

The process of prostate cancer diagnosis and treatment is a difficult journey for patients, and they need understanding, care, and empathy from people around them. Gathering the latest information on prostate cancer can help you understand the physical change and conditions of the patient, thus facilitate better communication.

Try to de-stress

Try to de-stress

As a caregiver, you are under huge stress. Learn how to de-stress and to deal with your own emotions, such as anxiety, distress, and negative feelings.

Seek help

Seek help

Caregivers are just ordinary people - we only have limited energy and capability. When caregivers find it difficult to deal with the caregiving work, they should be more open and seek help from other relatives, healthcare professionals, or community resources. Remember that you are not alone as a caregiver.

Talk to others

Talk to others

It is reasonable to have feelings and emotions when seeing our beloved one suffers, or when you have to take over the responsibility as a caregiver. Talk with your friends, family members, healthcare professionals, or patient's groups, sharing your feelings and avoiding the accumulation of negative emotions.

Be considerate

Be considerate

If the patient is your partner, you should understand that your sex life may be affected when your partner is undergoing chemotherapy, after the surgery, or when the disease is at advanced stages. Be considerate and treasure the time together.

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