Side effects

• Localised prostate cancer: this is where the cancer is only found in the prostate gland. Sometimes it is also known as early prostate cancer.
• Locally advanced prostate cancer: the cancer has extended beyond the prostate and may include seminal vesicles or other surrounding organs such as the bladder or rectum.
• Metastatic prostate cancer: the cancer has spread to distant parts of the body such as bone.

• Some side effects are minor and can be managed, while others may be more difficult
• Some side effects can be uncomfortable
• Some side effects can be serious health conditions that require more treatment
• Most side effects are reversible when treatments stop, but some are permanent
• Some people don’t experience any side effects from treatments, while some people experience many.
• Always talk to members of your healthcare team (e.g. doctor, nurse) about side effects because there may be ways of managing them.

Listed below are some questions you and your partner or the person you’re caring for may want to ask members of the healthcare team about treatment and side effec

1. What are the treatment options?
2. What are the expected advantages of each treatment option?
3. What are the disadvantages and side effects of each treatment option?
4. How can the side effects be managed?
5. What specific support and care is necessary for each option?
6. Will the side effects get better or worse as the treatment goes a long?
7. Are there things that can be done to help relieve the side effects?
8. What can be done before starting treatment to prepare for or reduce the impact of side effects?
9. Who should my partner or the person I’m caring for see about side effects?
10. Who should I see about information on care and support?
11. What resources and services are available to provide support?

• Incontinence: The removal of the prostate gland may affect the ability to control the flow of urine from the bladder. This is because the urethra (the tube that urine passes through as it leaves the bladder) runs through the prostate gland. The control mechanisms for urinary control (the bladder neck and the urinary sphincter) are located very close to the prostate and can be affected during the surgery. When the urinary sphincter is affected, people can experience stress urinary incontinence – losing control of bladder during physical activities (e.g. exercising) or strain (e.g. coughing, sneezing). All men will have a temporary urinary catheter for a short period after surgery. This is a thin, soft plastic tube that runs from inside the bladder to a bag outside of the body to collect the urine. Men normally need a catheter for a week after surgery, but sometimes up to three weeks. After the catheter is removed, it is not unusual to have some mild urinary incontinence. Improvement can occur quickly, but if it is still a problem by 6 months, then further treatments can help. Encourage your partner or the person you’re caring for to talk to members of his healthcare team if he is concerned.

  Tips:

  • Encourage him to talk to a continence nurse or physiotherapist for information on pelvic floor muscles training. Pelvic floor muscles are important for continence control (see www.bladderbowel.gov.au/adults/pelvicmen.htm), and are best learned and started before surgery and continued afterwards.
  • Talk to a continence nurse who can offer suggestions about the best continence products and specific needs. The Continence Aids Payment Scheme (CAPS) might provide financial assistance for continence products (see www.bladderbowel.gov.au/caps/capsfaq.htm).
  • Talk with a continence nurse about waste product disposal.

• Erectile difficulties: It is likely that he will have some difficulties getting and maintaining an erection after the surgery. How long this will last depends on a number of factors such as whether the erectile nerves were preserved at the time of surgery. The nerves that enable a man to have an erection are on either side of the prostate. If cancer has not grown near the nerves, a nerve-sparing operation may be able to be performed when removing the prostate. This increases the chance of a man regaining the ability to have an erection naturally. If these nerves are permanently damaged or removed, erectile difficulties may be ongoing. It is important to know treatments are available that can help. Members of the healthcare team can provide appropriate information.

  Tips:

  • Medications – Some medications in tablet and injectable forms can be prescribed to manage erectile difficulties. These medicines do have some side effects, and may not suit everyone. Tablet medications will only work if there has been nerve sparing surgery, but the injections can work even if the nerve has not been spared.
  • Implants/devices – Non-medication alternatives are available. Vacuum devices that draw blood into the penis (e.g. vacuum erection device) or the use of penile implants (e.g. flexible rods or inflatable tubes) could be ways of getting an erection.
  • Think about other ways that you and your partner could enjoy sex without penetration (e.g. oral sex, kissing, masturbation or mutual masturbation). Many men can still achieve orgasm without a full erection.
  • Talk with your partner about what feels good for you and ask what feels good for him.
  • Talk to the healthcare team about being referred to a professional (e.g. psychologist, sex therapist) or service that specialises in sexuality matters.

• Change in penis size: A possible side effect of surgery is a reduced length and width of the penis, while erect and/or flaccid/soft. This can be a major issue for some men. Your partner or the person you’re caring for may require support and assurance while getting used to the changes.

  Tips:

  • You and your partner or the person you’re caring for can talk with a health professional such as a psychologist, social worker or sex therapist/counsellor who can suggest strategies to help with managing feelings and perceptions about body image and changes in penis size.

• Changes during orgasm: The removal of the prostate can cause changes during orgasm. It is important to understand that after surgery he will have a ‘dry’ orgasm because semen is no longer produced. There is no ejaculate during orgasm, but he will still feel the muscular spasms and pleasure that produce the orgasm. The lack of semen and sperm means that he will not be able to conceive children naturally in the future. Other changes could include the following.
  • Painful orgasm: Pain is felt during orgasm but little is known about its cause. This usually settles after a few orgasms.
  • Leaking urine on orgasm: There may be some involuntary release of urine during orgasm.

  Tips:

  • Speak with a continence nurse or physiotherapist as they can offer techniques to improve any problems.
  • If he empties his bladder before intercourse or uses condoms, it can assist urine leakage during orgasm.
  • Talk with a health professional such as a psychologist or sex therapist/counsellor who can give you and your partner or the person you’re caring for strategies to help manage feelings and reduce the impact of any changes during orgasm.

• Infertility: Surgery for treating prostate cancer causes infertility. Even if you and your partner or the person you’re caring for may not be thinking about fertility now, having children or more children may be important in the future. If the doctor doesn’t raise fertility issues, you and your partner or the person you’re caring for can ask the doctor or a member of the healthcare team for information about what can be done before the surgery.

  Tips:

  • If fertility is important, you and your partner or the person you’re caring for could ask to be referred to a service that provides fertility-preserving options such as sperm banking (having some sperm stored) before he starts treatment. That way, having a child using stored sperm may be possible in the future.

Types of radiotherapy

The two main types of radiotherapy for treating prostate cancer are: 1) external beam radiation therapy (EBRT) and 2) brachytherapy (permanent low dose rate and temporary high dose rate).

External beam radiation therapy(EBRT)

EBRT involves aiming a beam of radiation at the prostate, from a machine outside of the body, to destroy or control the cancerous cells. The side effects from EBRT can be short-term and long-term. Unlike most short-term side effects that will lessen or disappear soon after treatment has finished, long-term side effects can last for several months or be permanent. The side effects include:

• Bowel and urinary problems – Because the bladder and bowel are close to the prostate, the radiation can affect these organs in ways that can cause changes to toileting routines. Urinary problems can include burning or stinging during urination, frequent urination or incontinence. Bowel problems can be mild and include looseness and frequency of bowel motions or incontinence. Occasionally, bleeding from the back passage (rectum) may occur.

’Men feel uncomfortable going out, because they’ve got pads and they’ve got nowhere to put them. It’s happening to all men, it’s not just the ones that have had surgery. And that doesn’t help people’s ego either. It can make them very depressed.’

• Skin changes: He may have temporary skin irritations between his legs and around the anus when he received treatment (e.g. skin becomes dry or itchy, and skin colour becomes darker).

  Tips:

  • Talk with the treating healthcare team if any skin irritations are experienced, they can suggest suitable treatments so it doesn’t get worse. Some other ways that can help to manage skin irritations include:
    • When washing, use water at a comfortable temperature and non-irritant soap
    • Keep skin clean and dry
    • Wear loose-fitting clothing
    • Check the skin as needed to look for any changes (such as soreness, a rash or redness) or broken skin that may lead to infection.

• Fatigue: Energy levels in your partner or the person you’re caring for may drop during and shortly after radiotherapy because of the effect the treatment has on the whole body. Fatigue in your partner or the person you’re caring for can also be caused by the demands of having treatment (e.g. travelling to the treatment centre), the chores he has to do even when he is feeling unwell, and the emotional stress of living with the disease.

  Tips:

  • Talk with the treating healthcare team about the possible causes of fatigue.
  • Talk with the healthcare team about ways to help your partner or the person you’re caring for cope better with fatigue. The team may develop a fatigue management plan for him. Some things he can do include:
    • Doing some light activities (e.g. short, easy walks) or weight bearing exercises can help him feel less tired
    • Making sure he gets plenty of rest by having regular breaks during the day
    • Doing what he has to do when he has the most energy
    • Planning activities he needs to do so he is not rushed
    • Prioritising activities so he only does those that are necessary
    • Asking for help so he doesn’t feel he has to do everything.

• Sexual difficulties: It may be some years before radiotherapy has any impact on his ability to have erections, but his ability to have erections can be affected after radiotherapy. This is because the treatment may cause changes to the nerves that control erections. When he ejaculates, the first few ejaculations may be painful. There may be less semen or no semen at all with time after radiotherapy of all types because of the effect the treatment has on the prostate and urethra. The amount of semen may also be reduced if hormone therapy is used with radiotherapy. [Please see Section 5 for ways of managing these difficulties.]

• Infertility: Radiotherapy can cause fertility problems because it damages the cells that make semen, and can affect his ability to have an erection. [Please see Section 5 for ways of managing this issue.]

• LDR: It is given by implanting permanent radioactive seeds directly into the prostate. The seeds give off a focused amount of radiation to the prostate with the aim of destroying the cancer cells. LDR brachytherapy is generally a treatment for men with localised prostate cancer. Placement requires surgery that may take a few hours but the treatment may be a ‘day-only patient’ or an overnight stay.
• HDR: It is also given by inserting radioactive material directly into the prostate but unlike LDR seeds, the placement of the material is temporary and for shorter periods – usually for a day or two at a time. The procedure takes place at a hospital but may require a longer stay than if receiving LDR brachytherapy. It is usually given in combination with EBRT for locally advanced disease.

• Bowel and urinary problems: Because the bladder and bowel are close to the prostate, the radiation can affect these organs in ways that can cause changes to his toileting routines such as needing to urinate more often or having diarrhoea, as well as other urinary and bowel problems such as blood in the urine or faeces, or discomfort when urinating. These effects could be less severe than EBRT because the treatment is localised to the prostate more accurately.
• Sexual difficulties: His ability to have erections can be affected over time because of the damage the treatment can cause to nerves that control erections. It is also possible that when he ejaculates, there is less semen because of the effect the treatment has on the prostate.
• Fatigue: Energy levels in your partner or the person you’re caring for may drop during and shortly after radiotherapy because of the effect the treatment has on the whole body. Fatigue in your partner or the person you’re caring for can also be caused by the demands of having treatment (e.g. travelling to the treatment centre), the chores he has to do even when he is feeling unwell, and the emotional stress of living with the disease.
• Infertility issues: Because radiation can affect sperm production during treatment, and if parenthood is a concern, it is important that you and your partner or the person you’re caring for speak with the doctor about fertility preserving procedures.

[For tips on managing these side effects, please see the EBRT section.]

• Loss of sex drive and erectile difficulties: Lowering testosterone levels may cause a reduction in sex drive and erectile difficulties. This will require you both to explore and develop new skills and responses during recovery.
  Tips:

  • Work with a health professional (e.g. psychologist, sex therapist) who specialises in sexuality matters.
  • Explore ways of being intimate with your partner that are not related to sex.
  • Medications – Some medications in tablet and injectable forms can be prescribed to manage erectile difficulties. Because these medications can have side effects, you and your partner or the person you’re caring can discuss with his healthcare team if they are suitable.
  • Implants/devices – If your partner or the person you’re caring for doesn’t want to use medications, vacuum devices that draw blood into the penis (e.g. vacuum erection device) or the use of penile implants (e.g. flexible rods or inflatable tubes) could be ways of getting an erection. Members of his healthcare team (e.g. urologist, nurse, sex therapist) can provide you with information about these.

• Hot flushes: Changes in his hormone level can trigger sudden intense hot sensations in his upper body.

  Tips:

  • Some medications can help with hot flushes.
  • Some complementary therapies can help with hot flushes (e.g. acupuncture).
  • Practise deep breathing and relaxation techniques.

• Tiredness (fatigue): Hormone therapy can make your partner or the person you’re caring for feel tired or lacking energy. He may already be tired from the cancer itself and everything being done to manage it.

  Tips:

  • Talk with the treating healthcare team about the possible causes of fatigue.
  • Talk with the healthcare team about ways to help your partner or the person you’re caring for cope better with fatigue. The team may develop a fatigue management plan for him. Some things he can do include:
    • Doing some light activities (e.g. short, easy walks) or weight bearing exercises can help him feel less tired
    • Making sure he gets plenty of rest by having regular breaks during the day
    • Doing what he has to do when he has the most energy
    • Planning activities he needs to do so he is not rushed
    • Prioritising activities so he only does those that are necessary
    • Asking for help so he doesn’t feel he has to do everything.

• Weight gain: changing the level of testosterone can cause him to retain fluid and gain weight.

  Tips:

  • Make some adjustments to his diet, if necessary. Talk to a health professional (e.g. dietitian) for advice and an eating plan.
  • Exercise regularly (e.g. walking, jogging, stair climbing, weights, dancing, tennis).

• Loss of muscle mass and strength: Hormone therapy can cause a decrease in muscle tissue or lean body mass, which can change the way the body looks and reduce muscle strength.

  Tips:

  • Talk to your partner or the person you’re caring for and encourage him to eat well and exercise.
  • Talk to a dietitian for advice and an eating plan.
  • Talk to the healthcare team about an exercise program that can maintain muscle mass and strength. You can share this activity.
  • Talk to the healthcare team about home safety, safe lifting and handling techniques to preserve your own back and safety while you are helping him.

• Swelling and tenderness in the breast area (gynaecomastia): The change in hormone levels can cause some enlargement of the breast area, which can be uncomfortable and tender.

  Tips:

  • Talk to a health professional (e.g. doctor) for advice.

• Thinning of the bones (osteoporosis): Lowered testosterone could lead to a loss of calcium and decreased bone density

  Tips:

  • Encourage regular exercise (e.g. walking, jogging, stair climbing, weights, dancing, tennis).
  • Maintain a healthy weight.
  • Take Vitamin D and calcium supplements.
  • See a health professional (e.g. doctor) for medications.
  • Talk to the healthcare team to get a home safety and a falls risk assessment done.
  • Contact Osteoporosis Australia for more information. (www.osteoporosis.org.au)

• Risk of heart disease: Some research has found that there is an increased risk of heart disease for men who are treated with hormone therapy.

  Tips:

  • Talk with members of the healthcare team to find out if your partner or the person you’re caring for has cardiovascular risk factors (e.g. heart problems, high blood pressure) before he starts hormone therapy.
  • Talk with members of the healthcare team (e.g. doctor) about ways of reducing the risk.

• Diabetes: Increased risk of developing diabetes or worsening existing diabetes.

  Tips:

  • Talk with members of the healthcare team (e.g. doctor, nurse) about risk of developing diabetes before starting hormone therapy.
  • Talk to the healthcare team (e.g. doctor, dietitian) about ways of managing his diabetes.
  • Contact the Australian Diabetes Council for more information (www.australiandiabetescouncil.com ).

• Mood changes: Dealing with all the challenges and losses that come with cancer can affect his mental health. Hormone therapy has also been shown to increase depression and anxiety in some men.

  Tips:

  • Talk to the healthcare team (e.g. doctor, nurse, psychologist) to discuss management options.
  • Support your partner or the person you’re caring for by talking with him about how he feels or encouraging him to talk to someone he trusts.
  • Remember that these changes may be caused by the treatments.
  • Encourage regular exercise (e.g. walking, jogging, stair climbing, weights, dancing, tennis).

• Problems with concentration and memory: Changes to the testosterone level can affect memory and concentration.

  Tips:

  • Talk to the healthcare team about how to manage memory loss or other cognitive problems.
  • Encourage your partner or the person you’re caring for to use a calendar or organiser to help keep track of important dates.
  • Encourage your partner or the person you’re caring for to write down things he has to remember.
  • Encourage your partner or the person you’re caring for to have plenty of sleep.

• Low red blood cells (anaemia): The body doesn’t have enough red blood cells so he can feel very tired or weak.

  Tips

  • Take iron supplements or vitamin B12 (ask the healthcare team for advice).
  • Talk to a health professional (e.g. dietitian) about an eating plan that is rich in iron and B vitamins.

• Low white blood cells (neutropenia): Chemotherapy can reduce the number of white blood cells in the blood. If your partner or the person you’re caring for has low white blood cells, he may be at increased risk of developing an infection. Infections during chemotherapy can be treated effectively with antibiotics.

  Tips

  • Take precautions to avoid infection.
  • Increase hygiene (e.g. hand washing).
  • Avoid being around people when they are sick.
  • Talk to the healthcare team (e.g. doctor, nurse) about ways of reducing infection risks, increasing his white blood cells and signs of infection (e.g. fever).

Signs of a severe infection may include fever (temperature higher than 38 degrees Celsius), chills, and severe sweats. If these symptoms develop, seek immediate medical advice, as treatment with strong antibiotics will be required.

• Fatigue: Tiredness can be caused by anaemia as well as other issues such as pain, depression, having trouble sleeping and the effect the treatment has on the whole body.

  Tips

  • Talk with the treating healthcare team about the possible causes of fatigue.
  • Talk with the healthcare team about ways to help him cope better with fatigue. They may develop a fatigue management plan for him. Some things he can do include:
    • Doing some light activities (e.g. short, easy walks) or weight bearing exercises can help him feel less tired
    • Making sure he gets plenty of rest by having regular breaks during the day
    • Doing what he has to do when he has the most energy
    • Planning activities he needs to do so he is not rushed
    • Prioritising activities so he only does those that are necessary
    • Asking for help so he doesn’t feel he has to do everything.

• Appetite changes: It is common during chemotherapy for people not to feel hungry or to find food tastes different.

  Tips

  • Encourage and support your partner or the person you’re caring for to:
    • Eat small meals and snack when hungry
    • Eat nutritious snacks such as dried fruits and nuts, yoghurt, cheese, eggs, milkshakes
    • Drink fluids between meals rather than with meals
    • Eat food that is cold or at room temperature if the smell of food makes him feel nauseous
    • Talk to a health professional (e.g. dietitian) about a diet plan that can improve appetite or food that is easy to eat.

• Bruising: Some people on chemotherapy find they bruise or bleed more easily because of the decrease in the number of platelets in their blood.

  Tips

  • Talk to members of the healthcare team (e.g. doctor, nurse) for advice.

• Constipation: Chemotherapy can change the digestive system, making it hard or painful to have bowel movements. Sometimes it is not chemotherapy that causes constipation but some of the other drugs taken when having chemotherapy (e.g. some anti-nausea drugs can cause constipation).

  Tips

  • Encourage your partner or the person you’re caring for to monitor their bowel movements to identify constipation early.
  • Talk with a dietitian about an eating plan that reduces constipation.
  • Encourage your partner or the person you’re caring for to do regular light exercise (e.g. walking).
  • Talk with members of the healthcare team (e.g. doctor, nurse) about medications that can ease constipation.

• Diarrhoea: Chemotherapy can also affect the digestive system by making people have frequent, soft, loose or watery bowel movements.

  Tips

  • Talk with a dietitian about an eating plan that reduces diarrhoea.
  • Encourage your partner or the person you’re caring for to drink water to help replace fluid lost through diarrhoea.
  • Talk with members of the healthcare team (e.g. doctor, nurse) about medications that can ease diarrhoea.

• Hair loss: Because chemotherapy affects the cells that make hair, the hair on the head and other parts of the body can fall out.

  Tips

  • Talk with members of the healthcare team (e.g. nurse) about ways of keeping the hair, scalp and skin healthy.
  • Suggest a hair piece if this would make your partner or the person you’re caring for feel more comfortable. A member of the healthcare team or your local Cancer Council (see contact details at the end of this booklet) can advise and help with getting a hair piece.
  • Talk with members of the healthcare team (e.g. psychologist) if changed appearance causes discomfort.

• Nausea and vomiting: Chemotherapy can cause nausea and vomiting. It is likely that he will feel better on days when he is not having treatment.

  Tips

  • Talk to a health professional (e.g. dietitian) about an eating plan that can help keep up food and fluid intake even when feeling nauseous.
  • Eat and drink small amounts frequently rather than eating large meals or drinking a lot at once.
  • Try to avoid smells that make him feel nauseous.
  • Talk with members of the healthcare team (e.g. doctor, nurse) for suggestions about medications that can ease nausea and vomiting from chemotherapy.

• Sore mouth and throat: Chemotherapy can affect the lining of the mouth so he is more prone to mouth ulcers, making it hard to eat or swallow.

  Tips

  • Talk to members of the healthcare team (e.g. doctor, nurse) about ways of managing sore mouth and throat.
  • Try different food and drinks to see what is easy to eat and drink.
  • Avoid alcohol, tobacco or other things that can irritate the lining of the mouth.

• Nerve changes: Some chemotherapy can lead to numbness, tingling, burning or weakness in some parts of the body.

  Tips

  • Talk to members of the healthcare team (e.g. doctor, nurse) about ways of managing these feelings. They may change his treatment to reduce these effects.

• Skin and nail changes: Chemotherapy sometimes can cause skin reactions such as making it itchy, dry and sore and the nails brittle and cracked.

  Tips

  • When washing, use non-perfumed soap or soap replacement (e.g. sorbolene cream).
  • Use products (e.g. moisturising cream) to stop skin dryness and cracked nails.
  • Wear loose-fitting clothing.

• Swelling: Swelling of the lower limbs can be caused by chemotherapy. Swelling of the lower limbs can also be a sign of the cancer spreading to the lymph nodes or an effect of other treatments which may have interrupted lymphatic drainage (such as when lymph nodes are removed from the body by surgery and damaged by radiotherapy). When lymph nodes do not drain lymph fluid properly, it can cause a build-up of fluid known as lymphoedema.

  Tips

  • Talk to members of the healthcare team (e.g. doctor, nurse) about ways of managing the swelling.

• Watery eyes and runny nose: Chemotherapy sometimes can affect the tear duct causing watery eyes, and a build-up of nasal fluid causing runny nose.

  Tips

  • Talk to members of the healthcare team (e.g. doctor, nurse) about ways of managing these effects.

• Infertility: Chemotherapy can cause infertility by preventing the body from making sperm. [Please see Section 5 for ways of managing this issue.]

• Improved communication, coordination and decision making between health professionals about the care
• Improved treatment planning because all treatment types and options are considered by a range of health professionals
• Improved coordination of services
• Improved delivery of services
• Improved quality of life.

When working with the healthcare team, you and your partner or the person you’re caring for may see the following health professionals:

• General Practitioner (GP): Provides ongoing care and works with other members of the treatment team
• Urologist*: A specialist in treating diseases of the urinary tract system and male reproductive organs
• Radiation Oncologist*: A specialist in the treatment of cancer using radiation therapy
• Medical Oncologist*: A specialist doctor who uses different drugs to treat cancer (such as chemotherapy)
• Endocrinologist*: A doctor who specialises in hormones, body chemistry and bone density
• Pathologist: Conducts tests to assess the stage and aggressiveness of cancer
• Radiologist: A specialist doctor who examines scans, X-ray and other imaging results
• Nurse (also known as Urology Nurse or Prostate Care Nurse): Provides treatment, support and assistance through all treatment stages
• Cancer Nurse Coordinator: Guides you, your family and the person you are caring for through cancer treatments and liaises with other care providers
• Continence Nurse: Helps manage any problems related to continence (urinary or bowel) care after treatment
• Pharmacist: Dispenses medications and offers medication advice
• Dietitian: Recommends the best eating plan while in treatment and recovery
• Physiotherapist: Specialises in movement and function of the body, advises on resuming normal physical activities
• Exercise Physiologist: Specialises in the benefits of exercises to help people get fitter for overall health or help people with a medical condition through exercise
• Occupational Therapist: Helps with the physical side of daily life by providing rehabilitation exercises
• Social Worker: Advises on support, practical and legal matters, and provides strategies to cope with emotional, social and spiritual challenges
• Psychologist, Psychiatrist or Counsellor: Provides strategies with decision making, problem solving, and dealing with psychosocial issues, including providing emotional and practical support and managing anxiety and depression
• Palliative Care Specialist: Expert in pain and symptom control who works closely with the treatment team
• Sex Therapist: Helps with sexuality issues by identifying the level of sexual functioning available, and enhancing sexual and relationship functioning
• Fertility Counsellor: Specialises in helping people with fertility concerns and issues, and can advise on fertility preservation options before starting treatments.

*These health professionals also use hormone therapy, also known as androgen deprivation therapy (ADT), as part of their treatment.

• Treatment
  Information for partners and carers of men affected by prostate cancer
• Side effects Information for partners and carers of men affected by prostate cancer
• Wellbeing Information for partners and carers of men affected by prostate cancer.