Expert Q&A: The Link Between Fatigue and Advanced Prostate Cancer — Plus Tips to Manage It
Most people who have advanced prostate cancer experience fatigue. Here, Joseph Renzulli, MD, explains what’s causing it and what you can do to feel more energized.
Many people with prostate cancer experience fatigue as a symptom of the cancer and as a side effect of treatment. In fact, up to 90 percent of men with prostate cancer experience fatigue.
Cancer-related fatigue, though, isn’t an average, run-of-the-mill tiredness. It’s a kind of exhaustion that can deplete your energy and motivation and even affect your ability to concentrate or make decisions. In some cases it’s even been linked to insomnia and depression.
Here, Joseph Renzulli, MD, an associate professor of urology at Yale School of Medicine, in New Haven, Connecticut, answers common questions about cancer-related fatigue, including what people with advanced prostate cancer can do to feel stronger and more energized.
Editor’s note: This interview has been edited for length and clarity.
Everyday Health: How does fatigue from advanced prostate cancer differ from general fatigue?
Dr. Joseph Renzulli: It’s a more profound type of fatigue. When you have advanced prostate cancer, your body just can’t go any further. It’s not like you’re tired because you stayed up late. It’s an intense halt of activity by your body, because you’re so fatigued.
Think of it like wanting to work out when you’re sick: Even if you wanted to, you can’t. Fatigue from advanced prostate cancer is something you can’t simply fight through.
EH: Is fatigue caused by the cancer itself or by treatment?
JR: Fatigue can be a symptom of advanced prostate cancer, but it’s more likely to be caused by the cancer treatments.
Plus, some treatments are more likely to cause fatigue than others. Hormone drugs, or androgen deprivation therapy (ADT), are the number one cause of fatigue. Oral medications called novel hormonal agents (or second-generation hormonal agents) are also associated with fatigue.
It’s not quite clear why these therapies are responsible for causing fatigue, though. It may be partly due to the hormonal changes. But even so, some hormone medications, such as enzalutamide, are much more likely to cause fatigue than others. So there’s clearly a medication-related component as well.
EH: Are there medications I can take to ease fatigue?
JR: There aren’t any treatments available that can help boost your energy levels. But in some cases, your doctor may be able to lower the dosage of your cancer medications, which might help you feel less fatigued. The key word is “might,” though. Oftentimes, patients don’t experience much of a benefit from the change.
EH: Are there any lifestyle changes I can make?
JR: It sounds counterintuitive, but the number one thing you can do to fight fatigue if you have advanced prostate cancer is to exercise. When you work out, you actually get that energy back.
Research shows this, too: One review found that resistance exercise — regardless of how much a person lifted or how often they worked out — can help ease cancer-related fatigue while boosting quality of life.
If working up the energy to exercise sounds too overwhelming, try finding an accountability partner. Other research shows that exercising with others — in a group or with a friend — has also been shown to motivate people with cancer to stick to their workout.
EH: Does my diet play a role in causing cancer-related fatigue?
JR: Some research has found that adopting a Mediterranean-style diet can help ease cancer-related fatigue in men who are overweight and being treated with ADT. Studies aside, eating a healthy diet can help you feel better overall. It may also help people lose weight, which can be good for people who’ve gained weight while on ADT, since the treatment has been linked to weight gain.
EH: I also have anemia. Is that contributing to my fatigue?
JR: Anemia is very common among people who have advanced prostate cancer — almost everyone has it to some degree. And while anemia can cause fatigue, it’s not clear if that alone is causing the low energy levels in people with prostate cancer.
EH: Can fatigue linger even after my treatment is over?
JR: It might, but that’s mainly caused by a lack of testosterone in the body, not any lingering effects from the treatment. In fact, you may continue to feel fatigued until your testosterone production ramps back up again, which could take about a year. That said, for about 20 percent of men over the age of 70, testosterone production will never reach the levels it did before starting ADT, even after stopping the medication.
EH: How important is it to tell my cancer care team about my fatigue?
JR: You shouldn’t hesitate to tell your care team about your symptoms, including any fatigue you might by feeling. A lot of people I treat think that because they have cancer, the fatigue isn’t that bad in comparison. But there are other people I treat who are so fatigued, they can’t even function. It’s a spectrum. It affects a lot of people differently.
It’s always worth bringing it up, though. Your doctor might be able to recommend an activity plan or support group that might offer some relief.
The Takeaway
Up to 90 percent of people with advanced prostate cancer will experience fatigue. It’s not just a feeling of tiredness, but also a more profound lack of energy.
While fatigue can be caused by the cancer itself, it’s mainly a side effect of the treatments for advanced prostate cancer, including hormonal therapies such as androgen deprivation therapy.
It may seem counterintuitive, but exercise is one of the best ways to boost your energy levels and combat cancer-related fatigue.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Cornford P et al. Fatigue in Prostate Cancer: A Roundtable Discussion and Thematic Literature Review. European Urology Open Science. May 2024.
Lopez P et al. What Is the Minimal Dose for Resistance Exercise Effectiveness in Prostate Cancer Patients? Systematic Review and Meta-Analysis on Patient-Reported Outcomes. Prostate Cancer and Prostatic Diseases. June 2021.
Baguley BJ et al. Mediterranean-Style Dietary Pattern Improves Cancer-Related Fatigue and Quality of Life in Men With Prostate Cancer Treated With Androgen Deprivation Therapy: A Pilot Randomised Control Trial. Clinical Nutrition. January 2021.
Walter Tsang, MD, is a board-certified medical oncologist, hematologist, and lifestyle medicine specialist. Inspired by the ancient Eastern philosophy of yang sheng ("nourishing life"), Dr. Tsang has developed a unique whole-person oncology approach that tailors cancer care and lifestyle recommendations to each patients’ biopsychosocial-spiritual circumstances. He partners with patients on their cancer journeys, emphasizing empowerment, prevention, holistic wellness, quality of life, supportive care, and realistic goals and expectations. This practice model improves clinical outcomes and reduces costs for both patients and the healthcare system.
Outside of his busy clinical practice, Tsang has taught various courses at UCLA Center for East West Medicine, Loma Linda University, and California University of Science and Medicine. He is passionate about health education and started an online seminar program to teach cancer survivors about nutrition, exercise, stress management, sleep health, and complementary healing methods. Over the years, he has given many presentations on integrative oncology and lifestyle medicine at community events. In addition, he was the founding co-chair of a lifestyle medicine cancer interest group, which promoted integrative medicine education and collaborations among oncology professionals.
Tsang is an active member of American Society of Clinical Oncology, Society for Integrative Oncology, and American College of Lifestyle Medicine. He currently practices at several locations in Southern California. His goal is to transform cancer care in the community, making it more integrative, person-centered, cost-effective and sustainable for the future.
Maria Masters is a contributing editor and writer for Everyday Health and What to Expect, and she has held positions at Men's Health and Family Circle. Her work has appeared in Health, on Prevention.com, on MensJournal.com, and in HGTV Magazine, among numerous other print and digital publications.
Dr. Joseph Renzulli offers his patients laparoscopic, robotic, and other minimally invasive techniques for treating urologic cancers, including prostate, kidney, bladder, and testicular cancers. A large focus of his practice is on men’s health, including a special interest in the diagnosis and medical and surgical treatment of prostate cancer. He is actively involved as primary investigator in multiple prostate cancer clinical trials.
Renzulli received his undergraduate degree magna cum laude in biology from Boston University, and his medical degree from Boston University School of Medicine. He completed his residency training at Yale School of Medicine before joining The Miriam Hospital and The Alpert Medical School of Brown University.
He is the Eastern Regional Director of Urology for Yale Medicine and Chief of Urology at both Lawrence + Memorial Hospital and Westerly Hospital.
