Hi, I'm Dr. Scholz. Let's talk about prostate cancer.
Today's video is about the side effects of radiation therapy. Side effects for prostate
cancer are so important partly because of the sensitive location of the gland and partly
because of the disease of prostate cancer isn't as life-threatening as other cancers.
So, quality of life after treatment takes on added importance. Since radiation therapy
has changed so much in the last decade, there's some points that need to be specifically addressed—things
that people used to fear with radiation which now in this modern era we're not concerned
about to any great degree.
The first one is, what about the radiation therapy causing a new cancer?
This concern was very strong in the early years. It was uncertain if people were going
to come down with other types of cancers. It is possible that there's a small incidence
of new bladder and rectal cancers after radiation therapy—perhaps 10-20 years after treatment.
The incidence, however, is known to be very, very small, and this information shouldn't
color your thinking about choosing radiation, especially since the surveillance methods
for these types of cancer are very good as well.
What about urinary incontinence? People assume that all treatments can cause incontinence,
but incontinence is really a side effect of surgery. Incontinence with radiation can occur
in very small sub-select cases which we'll cover briefly at the end of the video.
What about burns to the intestines? Devastating burns to the intestine were common in the
early years. Rectal burns, thankfully, due to a new technology called SpaceOAR have been
practically eliminated. Technology to reduce the risk of rectal burns had already been
greatly advanced even before SpaceOAR was released, but now with SpaceOAR we pretty
much don't need to be concerned with the possibility of rectal burns.
When you're thinking about side effects we group them into two large categories: short-term
side effects and long-term side effects. Let's cover short-term side effects first.
One general side effect, usually not very prominent, is some mild or moderate fatigue.
This fatigue causes people maybe to want to take naps in the afternoon and/but generally
will dissipate within six to eight weeks after the treatment is finished.
There can be some local soreness around the area of the rectum or with urinary function,
some burning discomfort, occasionally its prominent enough that people will take a radiation
holiday for a few days and then resume treatment, maybe take some analgesics. Those problems
usually will resolve usually within a month of completing therapy.
The long term protocols can be inconvenient. Sometimes people are treated for as long as
nine weeks, going Monday through Friday. Traveling back and forth for the therapy can be inconvenient
if you have to travel a long distance.
So short term side effects are quite manageable. It's the long-term side effects that we worry
about with radiation therapy.
At the top of the list let's put the impact on sexual function.
The first and most common is the development of impotence. The inability to get an erection
even when you're using something like Viagra or Cialis and this can occur in about half
the men that are treated and the incidence would be even higher in more elderly men.
The second problem that occurs is that men stop ejaculating any fluid when they have
orgasms. The prostate makes semen and radiation of the prostate will greatly reduce the ability
of the prostate to make semen.
The third thing is potential loss of fertility. Patients can indeed, on occasion, sire children
after radiation, and I've had patients that have done so, but that is relatively uncommon
and most men will not be able to have children through normal or natural means. With artificial
means, since men still have sperm in their testicles, artificial insemination is still
possible.
Let's cover a couple of the more rare but serious things that could be associated with
radiation.
The first problem is that when radiation is administered to the prostate the passageway
through the gland, the urethra, can in rare cases become very scarred, very inflamed,
and very scarred, and in some cases that scar tissue can actually start to block the passage
of urine. This is called a stricture; it can also occur with surgery. the doctors try and
work with scar tissue the best they can, but in probably less than 1% of patients, the
scar tissue can become so serious that the treatment of it could lead to incontinence
in rare cases. There are surgical corrective measures for this which are difficult and
you need to see very specialized experts. Fortunately, that is very rare, but a stricture
is possible.
The other problem that can develop over the long-term, and this is more common, is irritation
of the bladder base from the radiation, and the symptoms of that are men having greater
urinary urgency, greater urinary frequency, and waking up more frequently at night to
urinate. This can be very bothersome, it can interrupt sleep. This is a common problem
as men age and it can be exacerbated by radiation and some men perhaps, I'll pick a number of
around 10% of men that undergo radiation this problem can last for years after treatment.
The doctors do have medicines to try and soften the blow, and if we had medicines that could
always make it go away we wouldn't talk about it much, but in some cases, the medicines
do not cause complete resolution of the symptoms, and men are left with long-term urinary problems
as a result of their radiation therapy.
As a last point, I'd just like to emphasize that like any other treatment, the skill level
of the physicians does matter, and selecting centers of excellence that have more experience
and better training are going to give better results.
Thanks for watching. Subscribe to our Youtube channel and visit our website at PCRI.org