Radiotherapy, or external beam radiation therapy, for prostate cancer is considered the gold standard of prostate cancer treatment, and advances in technology now enables physicians to aim the beams of radiation more precisely, causing less damage to normal tissues, which in turn, means less side effects. Prostate cancer radiation therapy now uses advanced technology that is able to precisely aim the radiation beams and cause less trauma to the normal tissues. The treatment is painless and the side effects usually do not interfere with normal, daily activities. Even so, it is important to be aware of what the side effects of radiation of prostate cancer radiotherapy are.
The Side Effects of Radiotherapy for Prostate Cancer:
- Pubic Hair Loss
Radiation treatment for prostate cancer will not cause the hair on your head to fall out. However, the area that receiving the largest dose of radiation will have hair loss, so you may see changes in the hair on your lower abdomen or pubic area, which may be temporary or permanent.
- Fatigue
Fatigue, the most common of the side effects of radiation treatment for patients, appears around the middle to the end of treatment. It has been suggested that fatigue is the result from extra energy the body must spend to repair normal tissue after radiation. Usually mild to moderate, most men are able to continue with an eight-hour workday. Radiation-induced fatigue is rarely severe to require the need to take time off. It may warrant extra sleep at night or a nap during the day. Experts say that, during radiation treatment, for prostate cancer patients to minimize tiring effects, they should maintain their normal activities, or become more active if ordinarily inactive, suggesting light to moderate exercise.
- Changes in Bowel Movements
During radiation treatment, prostate cancer patients may experience changes in their bowel movements. Radiation proctitis, or radiation injury of the rectum or rectal wall, can cause symptoms such as pain, frequency and urgency of bowel movements and bleeding. Treatment symptoms can also include chronic burning and rectal discharge or leakage. With the development of image-guided radiation therapy (IGRT) and of intensity-modulated radiation therapy (IMRT), fortunately treatment symptoms such as this are becoming less common and less severe. Studies have shown about a third of men going through prostate cancer radiotherapy experience a slight increase of daily bowel movements, usually 2 to 3 a day. They may also have looser stools than usual. A doctor may suggest a reduced fiber diet or medications such as Imodium.
- Diarrhea and Stomach upset
Some prostate cancer radiotherapy patients also experience diarrhea and/or stomach problems. Most often these treatment symptoms are only mild to moderate and go away on their own. For men with more advanced prostate cancer, doctors recommend not to confine radiation treatment to the prostate. Cancer may have spread into the nearby lymph nodes, so radiation will include a large area of the intestines, which cause patients to experience these treatment symptoms. Occasionally, physicians will temporarily reduce the dosage or frequency of radiation treatment for prostate cancer patients, until these treatment symptoms start to go away. But usually these treatment symptoms are easily controlled with non-prescription anti-diarrhea medicine for the few weeks they are present.
- Changes in Urination
During radiation treatment for their prostate cancer, some men experience an increase in the need to urinate, including waking up during the night to urinate, or noctura. Prostate cancer radiotherapy can irritate part of the bladder’s inside lining near the prostate and the urethra, which is the tube that carries urine from the bladder through the prostate. About a third of men experience urinary tract irritation similar to a bladder infection, such as the inability to suppress the need to urinate, pain or burning when urinating and feeling the need to urinate but only urinating a small amount. Although these treatment symptoms are temporary, in some patients, they can become acute enough to require medication.
- Urinary Leakage
Radiation treatment for prostate cancer can cause scarring and injury to the muscle fibers located at the bladder neck or at the sphincter. When these tissues are damaged, they no longer snug up tightly, and the muscles of the bladder neck cannot squeeze effectively at the sphincter. As a result, some prostate cancer radiotherapy patients may experience urine leaking out when they cough, sneeze or strain. Some men become aware of leakage when they stand up, run or move around. Although the leakage is permanent, it is relatively uncommon for patients undergoing external beam radiation therapy for prostate cancer. However, for those do have this side effect, most do not regard it as a significant issue in their daily life.
- Bladder or Rectal Irritation
About 10 to 15% of prostate cancer radiotherapy patients run the risk of developing some degree of bladder or rectal irritation or both. Radiation injury of the rectum or rectal wall, or radiation proctitis, can cause these treatment symptoms, which can include bleeding, chronic burning and rectal discharge. Sometimes doctors will prescribe medications to help with the discomfort of these side effects of radiation for prostate.
- Bleeding in the rectum or bladder
One of the effects of radiation treatment for prostate cancer is the injury to inner surface lining of the rectum and bladder. As these tissues recover from the effects of prostate cancer radiotherapy, they create new blood vessels, which are close to the surface and are fragile until the healing process is complete. A small percentage of prostate cancer radiotherapy patients will experience blood in the urine or in bowel movements due to bleeding from these blood vessels. In severe cases, some men need surgery to correct this problem.
Sometimes blood in the urine can be seen after radiation treatment for prostate cancer has ended, sometimes many years later. It is very important not to assume the blood is caused by prior radiation treatment. Prostate cancer patients experiencing blood in their urine should contact their urologist for an evaluation.
- Erectile dysfunction
Impotence is of particular concern for men considering prostate cancer radiotherapy. A recent study shows that although the decline of the overall sexual function with men undergoing external beam radiotherapy for their prostate cancer was approximately the same for those who underwent radical prostatectomy, erectile dysfunction was more prevalent those who had prostate cancer radical prostatectomy.
Most men are able to have sex after prostate cancer treatment. About 30-50% of patients undergoing radiation treatment for prostate cancer experience some degree of impotence. It is thought that radiation narrows or blocks some of the small blood vessels responsible supplying blood to the penis and causing erections. After radiation treatment for their prostate cancer, men usually retain sensitivity to touch in the genital area, as well as their ability to achieve the sensation of orgasm. Some doctors encourage their patients to maintain or even increase their level of sexual activity during the course of treatment to maximize erectile function.
Some men have reported problems having sex after prostate cancer treatment. Sometimes it can take a year or more after treatment to manifest. The cumulative effect of radiation treatment takes a gradual toll on the ability to have erections. Over time, the small radiation-damaged blood vessels that control erection will shrink or become scarred, blocking the blood to flow to the penis and the ability to have an erection.
Men who are sexually active, under 60 and caught the cancer in its early stage, while it is still confined to the prostate, usually remain potent after prostate cancer radiotherapy and have no problems having sex after prostate cancer treatment has ended. While radiation should not have any effect on a man’s sexual desire, there are some men who find that the psychological stress of cancer diagnosis and treatment affects their ability to have an erection. Older men are more likely to have problems having sex after prostate cancer treatment, because they may be taking medications that interfere with their ability to have an erection or simply because of their advanced age and would have this issue regardless of the radiation treatment for their prostate cancer.
The side effects of radiation treatment for prostate cancer stem from the radiation on normal tissues, which are usually the bladder and the lower intestines or rectum. Also, since the blood vessels and nerves that control erectile function run along the outside of the prostate, they receive high doses of radiation over the length of treatment. For most men, early side effects of prostate cancer radiotherapy, such as changes in urination, subside a few weeks after treatment. Late effects typically are from the body’s healing of normal tissues and the ongoing, slow formation of scar tissue.
Some men experience prostate cancer radiation side effects as soon as a few days after treatment begins while others may not experience any side effects for most of their treatment. Generally, patients undergoing prostate cancer radiotherapy are able to still maintain their normal daily activities. If you are experiencing any of these treatment symptoms, you should consult with your doctor, who will be able to determine if your symptoms are simply part of your body’s healing process or if they are indicative of something more serious.
