Advanced prostate cancer may cause unpleasant symptoms. The symptoms can be relieved by treating the cancer itself. Sometimes treatments work very quickly and you may notice an improvement within a few days. At other times treatments may take longer to work and it can be a couple of weeks before you begin to feel their full benefits.

Apart from treating the actual cancer there are many other ways to help relieve symptoms. This section gives ideas on what maybe helpful.

There are many different types of painkillers. They vary both in their strength and in the way they work. Some painkillers are better for certain types of pain and some suit certain men better than others. If you are taking painkillers, it is better to take them regularly, even if you are not in pain when the next dose is due. This is because painkillers not only relieve pain at the time, but work to prevent it from coming back. Painkillers can be taken as tablets, liquids or as suppositories (by insertion into the back passage). Some are also given as injections under the skin.

It is important to tell your doctor or nurse if the painkillers you are taking aren't easing your pain. Your doctor can either change the dose or change the painkillers to one that will be more effective for you.

Pain caused by advanced prostate cancer cells in a bone can be severe. Radiotherapy is very good at easing this type of pain, but can take a few weeks to work. Often, drugs containing morphine are needed while the treatment is being planned or while you are waiting for the radiotherapy to work.

Some men find that morphine makes them feel drowsy when they first start taking it, but this usually only lasts for a day or so. Taking morphine may also make some men feel sick at first, and they may need an anti-sickness tablet (anti-emetic) prescribed by the doctor for the first few doses. It may also cause constipation.

A number of other drugs can be helpful in relieving pain. If pain is due to prostate cancer cells in a bone, non-steroidal anti-inflammatory drugs (NSAIDs) can help. These drugs have few side effects other than sometimes irritating the lining of the stomach.

Drugs called bisphosphonates can also help to relieve bone pain. They may be given into a vein (intravenously) in the outpatient department every 3-4 weeks or be taken as tablets. Some of the tablets must be taken on an empty stomach an hour or so before food and may cause stomach upsets.

Bisphosphonates can help to strengthen bones and lower the risk of fractures. They can also reduce high levels of calcium in the blood (hypercalcaemia) as well as reducing pain. Bisphosphonates that may be used include clodronate (Bonefos® or Loron®), ibandronate and zoledronic acid (Zometa®).

Your doctor can also prescribe sleeping tablets, or a mild relaxant, which may be particularly helpful if you are having trouble sleeping because of the pain. Anxiety and lack of sleep can make pain worse. For this reason some men also find that practising relaxation techniques helps them feel more comfortable.

Heat and gentle massage can also help ease aches and pains. A good long soak in a warm bath, a well protected hot-water bottle, and some baby oil or lotion massaged into the skin can often make a difference.

Being in pain can make you feel very low and it is important to let your doctor know if the drugs prescribed aren't working. It is also important to keep in mind that there are many different ways to control pain. There are also special NHS pain clinics run by doctors and nurses expert in treating pain. You can ask your doctor to refer you to a pain clinic if your pain is not controlled by any of the above methods.

If the bones in the spine are affected this can sometimes lead to weakness and tingling or numbness in the legs (due to pressure on the spinal nerves). If this is not treated the nerves may be permanently damaged. Treatment can often prevent damage, so if you develop any feelings of weakness, numbness or pins and needles in the legs, it is important to contact your cancer specialist immediately. Cancer in the spinal bones causing pressure on the spinal cord is known as malignant spinal cord compression.

You may find that you easily become very tired and that your body is no longer as strong and reliable as it once was, either because of the cancer, or because of the side effects of treatment.

You may feel as though you have no strength and everything is more of an effort.

It can be difficult to adjust if tiredness makes it difficult for you to drive or take part in sports, or if you have to walk more slowly than before. It will take time for you to get used to these changes and to accept having to rest, or not being able to do activities that you once took for granted.

If you have little energy, save it for the things you really want to do. Very often, re-organising your daily activities can be helpful - for example, by setting aside a time to rest every day. Practical aids such as wheelchairs can also be useful. You may feel that by using a walking stick, frame or wheelchair you are 'giving in' to your illness, but they can greatly improve your life, allowing you to move around more easily.

Sometimes the cancer or the treatment can cause anaemia, which can lead to tiredness. If this happens you may be given a blood transfusion, which can often give you more energy and reduce the tiredness.

Constipation can be caused by strong painkillers, or if there is too much calcium in your blood (caused by prostate cancer cells affecting a bone). Constipation can also occur if you lose your appetite and you are not eating as much as before.

Having fibre in your diet, drinking plenty of fluids and walking will help, but you may also need to take a medicine to stimulate the bowel (a laxative). Your doctor will be able to prescribe a suitable one for you. Your nurses can also advise you on ways to prevent or relieve constipation.

Even though you may feel tired it is not uncommon for men with advanced prostate cancer to have difficulty sleeping. There can be many reasons for this, not least that you probably have a lot on your mind.

Sleeping tablets can be helpful, and the newer types are less likely to make you feel drowsy the following day. You can also try some natural remedies for sleeplessness - malted milk drinks before bed, a glass of brandy or whisky in the evening, warm baths with soothing bath oils, or a relaxing body massage to relieve muscle tension.

Prostate cancer cells affecting a bone may make extra calcium pass out of the damaged bone and into the blood. High levels of calcium in the blood can make you feel extremely tired and thirsty, and pass lots of urine. Hypercalcaemia can also make you feel sick and some people become irritable and confused. Depending on your calcium level, you may be able to have treatment as an outpatient or you may need to spend a few days in hospital.

Your doctor will give you drugs known as bisphosphonates. These drugs are given as a drip. Each treatment takes between 15 minutes and one hour, and can be repeated every few weeks. They are usually effective at getting the calcium levels back to normal. Your doctor may also ask you to start drinking plenty of water. Sometimes it may be necessary to use a 'drip' to give extra fluids into a vein in your arm (an intravenous infusion).

If prostate cancer cells have weakened a bone so much that there is a risk of it breaking, you may need an operation. This is done under a general anaesthetic. The surgeon will put a metal pin into the centre of the bone and may also fix a metal plate to the bone. This holds the bone firm so that it will not break. The pin and plate can stay in permanently to protect the bone. This is mainly used for the long bones in the legs but is sometimes used for secondaries in other bones, such as the spine. If your hip is affected, the hip joint may be replaced.

You will need to stay in hospital for a week, or longer, after the operation so that you can recover fully. However, most men are able to get up and start walking a couple of days after the surgery.

This sort of operation may be done before radiotherapy is given, if there is a chance the bone may break before the radiotherapy has treated the cancer cells.

If the doctors feel the bone is not likely to fracture, bisphosphonates may be used to help strengthen the bone and prevent it breaking.

Some men find that complementary therapies or practices can help them to feel stronger and more confident in dealing with advanced prostate cancer. They can usually be used alongside conventional treatments and medicines.

Complementary therapies can help to improve quality of life and wellbeing, and can sometimes help to reduce symptoms. Some complementary therapies, such as meditation or visualisation can be done by the person with cancer themselves and can reduce anxiety. Other therapies, such as gentle massage, can be carried out by relatives or carers and can help them to support the person.

Physical contact and touch can be among the most powerful forms of support for people who are faced with uncertainty, fear or pain, whether emotional or physical.

Many hospices and hospitals offer complementary therapies alongside conventional care. These may include: aromatherapy, colour and sound therapy, massage relaxation, visualisation or guided imagery techniques and acupuncture.