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Pharmacy Link

EXTERNAL-BEAM RADIATION TREATMENT FOR PROSTATE CANCER: COMPLICATIONS

For the first few days or even the first couple of weeks of external-beam radiation therapy, you may feel nothing out of the ordinary; it takes a while for the cumulative doses of radiation to build up and have an effect. But by the third to fifth week, many men react with symptoms that can range from mild to severe; in most cases, these generally go away within days to weeks after the course of treatment is over. Sometimes, men develop these symptoms six months or more after treatment.

Most common complications are bowel problems (diarrhea, rectal itching or burning, urgency to have a bowel movement, painful cramps) and urinary trouble (feelings of urgency, painful or difficult urination, stress incontinence, and the need to urinate frequently, especially at night). For as many as 85 percent of men, these symptoms become acute enough to require medication.

In one analysis of 1,020 men treated in two large studies, about 7 percent of men needed to go to the hospital for treatment of more severe urinary problems. These included blood in the urine, bladder inflammation, and urethral stricture or bladder neck contracture—both caused when scar tissue develops and impedes urine’s progress out of the body. Urethral strictures accounted for more than half of these problems, and they seemed to develop mostly in men who had undergone a TUR procedure for BPH. Fewer than one percent of the men needed surgery to fix these problems. (A bladder neck contracture can be re-opened in outpatient surgery by a urologist, using a cystoscope, who makes a few tiny cuts to relax the tight scar tissue. Most urethral strictures respond well to dilation—stretching the urethra, in one or two sessions. Stubborn strictures may also be treated with tiny incisions, like those done to ease bladder neck contractures.)

Just a little over 3 percent of the men in this study experienced chronic

intestinal problems, including rectal inflammation, diarrhea, rectal bleeding, an intestinal ulcer or development of an anal stricture (tight scar tissue that can interfere with bowel movement); fewer than one percent experienced bowel obstruction or perforation. And complications that proved fatal were extremely rare—0.2 percent.

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