context: Many men who have advanced prostate cancer experience side effects. Some of these side effects result from the treatments used to slow the spread of cancer. Other side effects come from the disease itself. Understanding these side effects can relieve fears and help you cope better. So can being an active participant in your own care. Ask your doctor questions. Learn about potential symptoms and options before receiving treatments. Carefully weigh each option with your doctor's input. Impotence -- the inability to achieve or maintain an erection -- is a major side effect of most treatments for advanced prostate cancer. Among men who have both their testicles removed by a surgery known as orchiectomy, about 90% will experience impotence. Drugs to reduce testosterone levels, called androgen deprivation therapy or ADT, also causes impotence in most men. If this therapy is discontinued, many but not all men can regain erections over time, with no assistance. Treatments to improve erections include medicines taken orally or injected into the penis, vacuum erection devices,and penile implants. Discuss these options with your doctor including their likelihood of success and patient satisfaction before you have treatment that may result in impotence. Incontinence -- the inability to control urine flow -- is a common side effect of all therapies directed at the prostate gland. Most patients do eventually regain complete urinary control. Exercises to strengthen the sphincter and surrounding pelvic muscles can help you regain urinary control. These are called Kegel exercises. A training program called biofeedback helps reinforce the proper performance of Kegel exercises. Medications may also help relieve incontinence. An artificial urinary sphincter also can be surgically inserted in cases of severe incontinence. Ask your doctor about these options. Most treatments for prostate cancer cause infertility. Several techniques can help preserve fertility, but they must be done before cancer treatment has been initiated. If you want to preserve your fertility, tell your doctor before undergoing any treatment for prostate cancer. Prostate cancer most commonly spreads to the bones. This is called bone metastases. This condition can cause pain. It can also weaken bones and make them prone to fractures. So, too, can the endocrine therapy that's often used to slow the spread of prostate cancer. But doctors can offer treatments to relieve bone pain and support weakened bones. Bisphosphonates to Strengthen Bones These drugs help reduce or delay problems such as fractures caused by bone metastases in prostate cancer. The drug zoledronate is the most effective bisphosphonate in reducing fractures caused by prostate cancer and endocrine therapy. A new class of drugs, the rank ligand antagonists, specifically denosumab, has been found to be superior to zoledronate in reducing fractures in castrate independent prostate cancer. It is administered subcutaneously. Denosumab is also used to prevent osteoporosis caused by endocrine therapy for non-metastatic prostate cancer, The drug toremifene, a serum estrogen receptor modifier used primarily for metastatic breast cancer, is also useful in the treatment of osteoporosis related to prostate cancer. Both zoledronate and denosumab have the unique side effect of destroying the jaw bone. Therefore, before beginning either therapy dental disease should be addressed. Radiation Therapy for Bone Pain Radiation is given to reduce bone pain in advanced prostate cancer. External beam radiation therapy: Radiation using a high-energy X-ray machine that directs radiation to the painful bones Radioisotopes: Radiation therapy delivered through an injection that targets and attacks the area of bone containing cancer. Strontium 89 is a commonly used radioisotope. Radium 223 ( Xofigo) is a radioisotope used to treat metastatic prostate cancer, which improves pain and prolongs survival. Surgery to Stabilize Bones Doctors may recommend surgery to stabilize a weakened bone or bones. A surgeon may insert rods, plates, screws, wires, or other devices to provide support to bones damaged by metastasis. Surgery is usually performed only if there is an impending, or an actual, fracture. Other, Less Invasive Treatments to Relieve Bone Pain A newer noninvasive procedure uses MRI scanning to enable the surgeon to apply heat from ultrasound energy to destroy nerve endings in the bone around the tumor. This can provide relief from bone pain with a low risk of complications. It is indicated for men who are not candidates for external radiation or have failed that therapy. Other, minimally invasive treatments include the use of extreme cold or electrical current to reduce the size of or to destroy the tumor. Lifestyle Changes to Maintain Bone Health Specific lifestyle changes can help maintain bone health. They include decreasing alcohol intake, quitting smoking, doing regular weight-bearing exercises, and taking Vitamin D and calcium supplements.