Bowel And Bladder Problems
Radiation therapy for prostate cancer can irritate the bowel, the bladder, or both.
A person can develop:
- Radiation proctitis. The symptoms include diarrhea and blood in the stool.
- radiation cystitis. The symptoms include a need to urinate more often, a burning sensation when urinating, and blood in the urine.
Bladder problems may improve after treatment, but they may not go away completely.
What Does External Beam Radiotherapy Involve
You will have your treatment at a hospital radiotherapy department. Youll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. Theyll talk to you about your treatment plan and ways to manage any side effects.
Before your radiotherapy treatment
Radiotherapy planning session
A week or two before your treatment, youll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.
During your radiotherapy treatment
You will have one treatment at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.
If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.
At some hospitals, youll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, youll receive a slightly larger overall dose of radiotherapy but the dose you receive at each session will be lower than if you have 20 sessions.
Its safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesnt stay in your body so you wont give off any radiation.
Advantages And Disadvantages Of External Beam Radiotherapy
- You dont need a general anaesthetic and you dont need to stay overnight in hospital.
- You may be able to work and carry on normal activities during the treatment.
- You are not radioactive during or after the treatment so you can be in close contact with others.
- Each treatment is relatively short. It usually takes about 15 minutes, although you may be in the radiotherapy department for up to an hour.
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What To Expect For Your Treatment
Youll get ERBT at a hospital or clinic. Youll likely not have to stay overnight. The total length of time for your treatment depends on the type and dose of radiation, as well as why you are getting it. For instance, if youre getting radiation as the main treatment for an early-stage prostate cancer, youll likely get treatments 5 days a week for several weeks in a row. If youre getting radiation therapy to treat bone pain, youll probably need fewer treatments.
Each treatment is much like getting an X-ray, but the radiation is stronger. You lie on a table while the machine delivers the radiation. The actual treatment is quick and doesnt hurt, but getting you into the proper place for treatment each time takes longer. When you are in the right position, the radiation therapist leaves the room and controls the machine. The therapist can see you. And you can talk with and hear the therapist the whole time.
Your radiation oncologist or nurse can tell you what to expect during treatment.
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If Youre Having Radiation Therapy To The Pelvis
Radiation therapy to the pelvis can cause side effects such as:
- Bladder problems
- Fertility problems
- Changes in your sex life
You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.
Radiation to the pelvis can cause problems with urination, including:
- Pain or burning sensations
- Blood in the urine
- An urge to urinate often
Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:
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Having Radiotherapy For Prostate Cancer
You have external beam radiotherapy as an outpatient in the radiotherapy department. Radiotherapy is given using a machine that is like a big x-ray machine. This is called a linear accelerator .
You usually have it as a series of short, daily treatments. The treatments are given from Monday to Friday, with a rest at the weekend. Radiotherapy is not painful, but you will need to lie still while you have it.
You may have radiotherapy over either:
- 4 weeks the dose you get for each treatment session is higher.
- 7 weeks the total overall dose of radiation is higher.
Both ways are effective, and the side effects are the same. You usually have radiotherapy over 4 weeks as it is a shorter treatment.
If you have a type of radiotherapy called stereotactic ablative radiotherapy you have it over a much shorter time.
Your doctor or nurse will explain how long your course of radiotherapy will take. It is safe for you to be with other people during external radiotherapy, including children.
There are different techniques used to treat prostate cancer more effectively. They treat the cancer while protecting healthy tissue and reducing side effects.
Possible Long Term Side Effects
Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later. This includes problems getting an erection.
Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021
Cancer: Principles and Practice of Oncology VT DeVita, TS Lawrence, SA RosenbergWolters Kluwer, 2019
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Signs And Symptoms Of Prostate Cancer
Most prostate cancers are found early, through screening. Early prostate cancer usually causes no symptoms. More advanced prostate cancers can sometimes cause symptoms, such as:
- Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night
- Trouble getting an erection
- Pain in the hips, back , chest , or other areas from cancer that has spread to bones
- Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord
Most of these problems are more likely to be caused by something other than prostate cancer. For example, trouble urinating is much more often caused by benign prostatic hyperplasia , a non-cancerous growth of the prostate. Still, its important to tell your health care provider if you have any of these symptoms so that the cause can be found and treated, if needed. Some men might need more tests to check for prostate cancer.
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Brachytherapy Or Internal Radiation Therapy
Internal radiation therapy , also known as brachytherapy, involves placing radioactive seeds on the prostate gland inside the body. The seeds are around the size of a grain of rice.
The implant may be temporary or permanent:
- Temporary: The doctor inserts the seeds into a small tube and leaves them there for between 5-15 minutes . A person may need 1-4 sessions, typically over the course of 2 days.
- Permanent: The doctor will place around 1000 radioactive seeds that release radiation for several weeks to months. Often, they leave the seeds in place when not active since they likely will not cause discomfort.
Before inserting the seeds, the doctor will give the patient either a general or local anesthetic. They may use imaging technology to help ensure they position the seeds accurately.
Urinary And Bladder Changes
Radiation therapy to the pelvis can cause urinary and bladder problems by irritating the healthy cells of the bladder wall and urinary tract. These changes may start 35 weeks after radiation therapy begins. Most problems go away 28 weeks after treatment is over. You may experience:
- Burning or pain when you begin to urinate or after you urinate
- Trouble starting to urinate
- Bladder spasms, which are like painful muscle cramps
Ways to manage include:
- Drink lots of fluids. Aim for 68 cups of fluids each day, or enough that your urine is clear to light yellow in color.
- Avoid coffee, black tea, alcohol, spices and all tobacco products.
- Talk with your doctor or nurse if you think you have urinary or bladder problems. You may need to provide a urine sample to check for infection.
- Talk with your doctor or nurse if you have incontinence. He/she may refer you to a physical therapist to assess your problem. The therapist may recommend exercises to help you improve your bladder control.
- Your doctor may prescribe medications to help you urinate, reduce burning or pain, and ease bladder spasms.
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Diarrhea Flatulence Or Painful Defecation
These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.
Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.
How Can I Reduce Skin Reactions
- Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Donât rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
- Try not to scratch or rub the treated area.
- Donât put any ointment, cream, lotion, or powder on the treated area unless your radiation oncologist or nurse has prescribed it.
- Donât wear tight-fitting clothing or clothes made from harsh fabrics like wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers like cotton.
- Donât apply medical tape or bandages to the treated area.
- Donât expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
- Donât expose the treated area to direct sunlight. That could intensify your skin reaction and lead to a severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.
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How Long Do Side Effects Last
Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.
Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and cant do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment youre getting. Tell your cancer care team about any side affects you notice so they can help you with them.
External Beam Radiation Therapy
In this type of therapy, a machine outside the body is used to focus the beams of radiation on the prostate gland. It is used to treat early stages of cancer and helps to relieve you from symptoms such as pain.
Before the procedure, you will undergo simulation, which is a planning session. During this session, the radiation team takes measurements to find the correct angles for aiming the beams and the proper dosage.There are various types of EBRT namely:
- Intensity-modulated radiation therapy
- Three-dimensional conformal radiation therapy
- Stereotactic body radiation therapy
- Proton beam radiation therapy
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Hormone Therapy Side Effects
Testosterone is the primary male hormone, and plays an important role in establishing and maintaining typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body. The primary systemic …
Questions To Ask Your Doctor Nurse Or Radiographer
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What type of radiotherapy will I have?
- How many sessions will I need?
- What other treatment options do I have?
- What are the possible side effects and how long will they last?
- What treatments are available to manage the possible side effects from radiotherapy?
- Will I have hormone therapy and will this carry on after radiotherapy?
- How and when will I know if radiotherapy has worked?
- If the radiotherapy doesnt work, which other treatments can I have?
- Who should I contact if I have any questions?
- What support is there to help manage long-term side effects?
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When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.
New Study Compares Long
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Prostate cancer therapies are improving over time. But how do the long-term side effects from the various options available today compare? Results from a newly published study are providing some valuable insights.
Investigators at Vanderbilt University and the University of Texas MD Anderson Cancer Center spent five years tracking the sexual, bowel, urinary, and hormonal status of nearly 2,000 men after they had been treated for prostate cancer, or monitored with active surveillance . Cancers in all the men were still confined to the prostate when diagnosed.
Dr. Karen Hoffman, a radiation oncologist at MD Anderson and the studys first author, said the intent was to provide information that could help men choose from among the various therapeutic options. Surgical and radiation techniques have changed significantly in the last few decades, and at the same time, active surveillance has become an increasingly acceptable strategy, she said. We wanted to understand the adverse events associated with contemporary approaches from the patients perspective.
Roughly two-thirds of the men enrolled in the study had favorable risk cancer, which is nonaggressive and slow-growing. A quarter of these men chose active surveillance, and the rest were treated with one of three different methods:
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Prostate Cancer: Radiation Therapy
Radiation can be given from a machine outside the body and directed at the prostate . Or a surgeon can place radioactive materials into the tumor . These radioactive materials can be temporary or permanent.
Life After Cancer Treatment
After you finish treatment for cancer, give yourself time to adjust to the physical and emotional changes. We are still here to support you after your treatment finishes.
You will need regular check-ups with your treatment team. These may include some blood tests or physical examinations. Speak with your treatment team about the plan for you.
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