Around three in four men with prostate cancer (74%) will have fatigue at some point (Stone et al, 2000). For some it may be a short-term problem and manageable, for others it can be longer lasting and can impact quality of life. 

As health professionals, it can be a complex symptom to address as treatments or solutions may feel limited. Men say there is little discussion about their fatigue with health professionals and there may be differing perceptions of the impact of fatigue on quality of life (Sonn et al, 2013).  

The specialist nurses at Prostate Cancer UK are trained and experienced in helping men understand and better manage their fatigue. 


Fatigue is a feeling of extreme tiredness that does not go away, even after rest. Ream and Richardson (1996) say that in people with cancer, fatigue is: 
A subjective, unpleasant symptom which incorporates total body feelings ranging from tiredness to exhaustion creating an unrelenting overall condition which interferes with individuals’ ability to function to their normal capacity. 

Men seeking support from the specialist nurse telephone service consistently feedback that acknowledging the existence of their fatigue and having the opportunity to explore it in more detail with a health professional can be the most important part of the service: 
I think first of all realising that you’re not actually sort of alone, that it is a recognised problem [is important]. 

I felt listened to and very well supported. It was good to talk to someone who was honest with me. 

Speaking to someone about my fatigue made me more aware of it and so I was able to work against it in a more effective way. Being told it was possible to change things also helped. It was good to have fatigue recognised as a problem that can be changed. 


The causes of fatigue are multifactorial and might include the stress of a diagnosis, sleep disturbance, depression, and social factors. Treatments for prostate cancer, such as radiotherapy and androgen deprivation therapy (ADT) are common causes of fatigue (Alibhai et al, 2006; Kyrdalen et al, 2010). The majority of men seeking fatigue support, are on, or recovering from ADT.


When men contact the specialist nurses, they can receive written information about fatigue management as well as a diary and planner. Completing a fatigue diary, including a fatigue scale, is a good way of looking for patterns in energy levels and the impact fatigue has had on day-to-day life. They can talk at length to a specialist nurse trained in fatigue management, with calls often taking up to an hour. A follow-up call may also be offered.  

Speaking to a nurse specialist provides the opportunity for men to discuss the effect fatigue has had on their ability to work, exercise, complete chores, as well as the impact on their relationships, social activities and hobbies. We discuss daily routine and how they have been managing their energy levels and consider the impact this has on their mood and motivation. 

Together the nurse and the caller start to develop a plan and set some small goals. Men are encouraged to complete a weekly planner to provide realistic expectations and a sense of control for the coming week. 


Using the five Ps to conserve energy provides a useful framework for discussion about fatigue management and making changes (Prostate Cancer UK; figure 1).  

Figure 1. The five Ps. 


Men often talk of ‘battling through’ their fatigue. It can be helpful to start with permission to do things differently, for example to rest and recharge when needed.  


Making a written list helps to prioritise what needs to be done, what could be delayed or where help could be sought to complete jobs or chores. Hobbies and interests may be neglected when suffering from fatigue. It is also important to prioritise things to look forward to and provide a boost. 


The fatigue diary might highlight energy levels that are better at certain times of the day and help men to plan activities. There needs to be a careful balance of activity and rest. After a meal is a good time to plan a rest. If men find a nap helpful, we suggest limiting it to 30 minutes and before 3pm to avoid it affecting sleep at night. 
Men coping with fatigue at work might find extra challenges. Employers should ensure reasonable adjustments are made (Macmillan Cancer Support, 2019).  


It might be necessary to break down chores and longer activities into manageable chunks. Exercise has been shown to be beneficial for people with cancer related fatigue and has particular benefit in managing the side effects of ADT (Schmitz et al, 2010; Taaffe et al, 2017). We consider how men can remain active and enjoy exercise safely.  


We consider how a task can be made easier. Can it be done sitting rather than standing or are there any aids or equipment that could help? 

Specialist nurse service 

 Our specialist nurses have a broad experience across urology, oncology and palliative care. They provide support and information to people on a range of prostate cancer topics, such as prostate-specific antigen (PSA) testing. They also provide support to health professionals.  

To find out more:


The specialist nurse service provides men with the time necessary to discuss and understand their fatigue and its impact. A conversation can lead to a new approach to managing energy levels and minimising the impact of fatigue on quality of life.  
 It has completely changed my outlook, I am more positive in every way.  


Alibhai SMH, Gogov S, Allibhai Z (2006) Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: a systematic literature review. Crit Rev Oncol Hematol 60(3): 201–215 

Kyrdalen AE, Dahl AA, Hernes E, Hem E, Fosså SD. (2010) Fatigue in prostate cancer survivors treated with definitive radiotherapy and LHRH analogs. The Prostate 70(13): 1480–1489 

Macmillan Cancer Support (2019) Your rights at work when you are affected by cancer. Available online:  

Prostate Cancer UK. Living with prostate cancer: fatigue. Available online:  

Ream E, Richardson A (1996) Fatigue: a concept analysis. Int J Nurs Stud 33(5): 519-529 

Schmitz KH, Courneya KS, Matthews C, et al (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc42(7): 1409-1426 


Sonn AG, Sadetsky N, Presti JC, Litwin MS  (2013) Differing perceptions of quality of life in patients with prostate cancer and their doctors. J Urol 189( Suppl): S59-S65 


Stone P, Hardy J, Huddart R, A’Hern R, Richards M (2000) Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer 36(9): 1134-1141