Prostate cancer and lymphoedema
Prostate cancer is the most common cancer diagnosed in Australia.
Management of prostate cancer is dependent upon a number of individual person characteristics identified at the time of diagnosis. Treatment may include surgery (the extent is determined by the size and extent of the tumour), radiotherapy that may be targeted to the local area or include other structures (e.g. lymph nodes) in the surrounding area, and hormone manipulation therapy. Chemotherapy may be offered in particular circumstances. Each treatment may result in physical changes, the impact of which can be reduced with physiotherapy.
Physiotherapists are qualified to be an integral part of multi-disciplinary teams involved in the management of men with prostate cancer. Physiotherapists can proactively assess and monitor for early detection of problems to allow for their prompt treatment. In addition to continence issues that may occur, movement disorders, deconditioning and fatigue, muscle weakness and impaired balance, lymphoedema and other physical problems may occur.
If treated early, these can be modified and managed to minimise long-term functional impairments, ensuring optimal participation in life. Individual focussed care utilising a physiotherapy rehabilitation model of care can have a positive impact on your quality of life.
Why should men be physically active?⊖⊕
Prostate cancer treatments can impact your physical capacity, resulting in impairments to the musculo-skeletal system, balance, fitness, work capacity. Changes in your continence, erectile function, muscle strength, endurance, fatigue, bone density, balance and general well-being can be improved with appropriate rehabilitation programs.
Appropriate prescription of therapeutic exercise for rehabilitation before, during and after cancer treatments can significantly assist in addressing muscle strength and mass, balance impairments, physical retraining, management of ongoing side-effects of treatments, improving quality of life. Regardless of what stage of prostate cancer, men who are physically active have a better quality of life than those who are not. General guidelines for physical activity in men may need to be modified for individual men (you) with variations to address any specific issues resulting from your treatment(s), stage of prostate cancer or other pre-existing injuries or physical problems.
Research studies show that there are many benefits associated with exercise during and following treatment for cancer. Specifically, the reported benefits from exercise trials include improvements in strength, cardiovascular fitness, immune function, mood, and self-esteem. There are also reported reductions in the number of symptoms and side effects such as nausea, fatigue, and pain, as well as in stress and anxiety levels.
Physiotherapists can prescribe appropriate reconditioning and return to work programmes. In addition to your general activity, such programmes should include activities to address strength by progressive resistance exercises, cardiovascular fitness training, balance and falls prevention, continence management, bone health and education regarding management of fatigue and workload during and after your treatment.
Prostate cancer and lymphoedema⊖⊕
Lymphoedema is a swelling that may occur after treatment as lymph fluid builds up when flow is reduced from a part of the body. Lymph fluid drains from the tissue spaces through vessels that pass through the lymph nodes and eventually drains back into the blood circulation. Lymph nodes are located in armpits, groins, abdomen, chest and neck to filter out harmful bacteria and assist in the body’s response to infection. The movement of lymph fluid around the body is dependent upon changes in tissue pressure that occur with deep breathing, muscle contraction and movement.
More radical surgery for prostate cancer, such as radical prostatectomy may include the removal of lymph nodes in the pelvic area and/or groin area. For some men, radiotherapy may be required to the area where lymph nodes affected. This results in an obstruction to the flow of lymph fluid flowing from the area of the body drained by the treated lymph nodes. For some men, swelling of the lower trunk, scrotum or leg(s) may occur. Early detection and treatment is available to minimise this.
Lymphoedema may present at any stage after surgery or radiation with symptoms of ache, heaviness, tightness or swelling most commonly reported. It is usually a slow and gradual increase in swelling and symptoms in the leg(s), lower body trunk or genital area.
Not every man will develop lymphoedema after surgical removal or radiotherapy to the pelvic or groin lymph nodes but it is known that early detection and intervention can assist in minimising its impact. Other factors that may increase the risk of developing swelling could include infection, higher body mass index (being overweight or obese) or immobility (lack of use or reduced physical activity).
Physiotherapists who diagnose and manage lymphoedema have completed additional specific training. Lymphoedema is diagnosed by patient history and physical examination with various forms of objective measurements.
Options to manage lymphoedema⊖⊕
There are many options to manage lymphoedema, and depending upon the your presentation may include:
- Specific massage (manual lymphatic drainage)
- compression therapy (bandaging and/or compression garments, pumps)
- low level laser therapy and other treatments as they are developed.
Treatment may include a combination of these to achieve the best improvement for you.
A major component of lymphoedema treatment is self-management of this chronic condition which should be developed in partnership with your treating physiotherapist. Things that are suggested to assist in reducing load on a compromised lymphatic system include:
- Maintain healthy weight range
- Good skincare which involves using moisturiser and using protective clothing when appropriate
- Avoid trauma or infection – if an injury occurs in the limb at-risk or with lymphoedema, seek prompt medical review or advice
- Participate in regular physical activity but seek health professional advice before starting a new activity
- Monitor your limb for changes in size or symptoms periodically and seek advice if changes are observed.