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Blood In Urine After Radiation For Prostate Cancer

Types Of Prostate Radiation

Prostate Hematuria ( Blood in urine) and PAE ( prostate artery embolization)

The most common types of radiation for prostate cancer are external beam radiation and brachytherapy .

1. This type of radiation uses beams of radiation, which are focused on the prostate gland from a machine outside the body. Its very helpful in the early stage of prostate cancer or in cases when it is needed to relieve pain symptoms . Such treatment is usually done 5 days a week for several weeks, depending on the condition of the patient. External beam radiation for treatment of prostate cancer has different categories of treatment, such as:

  • Three-dimensional conformal radiation therapy
  • Intensity-modulated radiation therapy
  • Stereotactic body radiation therapy
  • Proton beam radiation therapy.

2. Brachytherapy for prostate cancer also called seed radiation for prostate cancer uses very small balls or pellets, which are placed into the patients prostate. Seed radiation differs in the dosage rate of the radioactive material: permanent and temporary .

Study Design And Patients

This study was designed as a retrospective cohort study. We retrospectively reviewed all consecutive patients who received palliative radiotherapy between October 2006 and May 2020 in two hospitals, the University of Tokyo Hospital and St. Lukes International Hospital in Tokyo, Japan, to control gross hematuria. The inclusion criteria were patients who had gross hematuria due to advanced cancer and received radiotherapy with palliative intent. The exclusion criteria were patients who received radiotherapy for definitive treatment or palliative radiotherapy for reasons other than gross hematuria.

Genitourinary Toxicity With Intensity

Intensity-modulated radiotherapy has been shown to deliver higher doses to the target area while minimizing complications. IMRT is increasingly used for the treatment of prostate cancer doses of 81 Gy have been delivered. The complication rate with IMRT is lower than that with 3-dimensional conformal beam therapy, although not all studies show a significant difference.

The frequency of toxicity with IMRT versus the frequency with 3D conformal radiotherapy is as follows.

  • Grade 2: IMRT, 17-36% 3D conformal radiotherapy, 42-60%
  • Grade 3: IMRT, 0.3-0.5% 3D conformal radiotherapy, 1-2%

After treatment for prostate cancer, rectal complications are much lower with conformal beam therapy than with 4-box, small-field therapy however, the incidence of bladder complications is unchanged, probably because of the proximity of the bladder neck and unavoidable exposure to the urethra.

IMRT has also demonstrated a significant improvement in rectal complications compared with 3D conformal radiation therapy. Fewer grade 2 bladder complications occur with IMRT, but the rates of grade 3 complications are similar. GI symptoms can be further reduced by using fiducial markerbased position verification in patients with prostate cancer.

A multicenter, phase II study conducted by Kim et al found that in patients with rectal cancer, preoperative chemoradiation with cetuximab, irinotecan, and capecitabine was active and well tolerated.

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Radiation Cystitis Causing Hematuria

Less common but challenging to treat is what we call radiation cystitis. This occurs in 1-2% of men after radiation treatment to the pelvis all the prostate. The bladder and the prostate become friable and bleed easily. Hematuria as a result of radiation cystitis typically occurs many years after treatment. A number of treatment options available, including fulguration, intravesical instillations, medical treatment. Hyperbaric oxygen treatment has been shown to be beneficial for men with persistent intermittent hematuria.

If you experience blood in urine before, after, or during treatment for prostate cancer, urological evaluation should be sought.

How Long Does It Take For Radiation Side Effects To Go Away

Radiotherapy for Prostate Cancer

The general effects of radiation therapy like fatigue, nausea, and headaches resolve fairly quickly after treatment. Your body just needs time to process the radiation but can recover within a few weeks.

Delayed side effects of radiation therapy, on the other hand, may require further treatment to alleviate. Its important to use an ongoing therapy like hyperbaric oxygen therapy to enhance the bodys healing response and optimize the bodys response to radiation damage. Without additional care, some radiation side effects like burns and inflammation can morph into chronic, non-healing wounds that trigger additional health complications.

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Prostate Radiation Vs Robotic Prostatectomy

It is not possible to decide which treatment is better or more effective radiation or robotic prostatectomy, due to the fact that everybody has different stages of prostate cancer and other health-related issues. Below are enumerated pros and cons for each type of treatment, but every patient needs to take into account what his doctor is telling and suggesting.

Possible Side Effects Of Radiation Treatment For Prostate Cancer

The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.

You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.

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Hematuria May Occur Years After Brachytherapy

    Gross hematuria can occur in men up to several years after undergoing prostate brachytherapy, according to a study.

    The condition is more likely to develop in men with larger prostates volumes , those who also undergo external beam radiotherapy , and those who are free from biochemical failure, researchers reported online ahead of print in BJU International.

    Michael S. Leapman, MD, and collaborators at the Mount Sinai School of Medicine in New York reviewed hematuria outcomes in 2,454 patients who had transperineal prostate brachytherapy over a 20-year period. The study population had a median follow-up of 5.9 years.

    Of the 2,454 patients, 218 reported gross hematuria at a median time of 772.2 days after seed implantation.

    Only 3.8% of men with PSA failure reported hematuria compared with 9.4% of those with biochemical control, the researchers noted. A possible explanation for this finding is that differences among patients may affect their response to radiation, with respect to both toxicity and disease control. Patients who are more sensitive to radiation may be more likely to have a favorable treatment response, but also experience increased mucosal injury or necrosis that leads to hematuria, Dr. Leapmans group explained.

    The authors pointed out that the significance of observed blood in urine after permanent brachytherapy remains unclear and warrants further study to understand the etiology and clinical course of this morbidity.

    Are There New Techniques That Reduce The Chance Of Becoming Incontinent

    Fixing Urinary Leakage After Prostate Cancer Surgery | Ask A Prostate Expert, Mark Scholz, MD

    When removingthe prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.

    Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.

    Continued

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    Side Effects Of Prostate Radiation

    Side effects of prostate radiation is an important topic, which many doctors and their patients have to discuss before proceeding to the procedure further on. In most cases, radiation treatment for prostate cancer has the same side effects as brachytherapy . But its important to keep in mind that every person will have different side effects from the same procedure and health in general.

    Blood In Urine After Radiation For Prostate Cancer

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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.

    Questions To Ask Your Doctor Or Nurse

    Chronic radiation proctitis: prevention better than cure ...
    • Is the treatment Im having for prostate cancer likely to cause any urinary problems?
    • What type of urinary problems might I get?
    • What should I do if I cant urinate?
    • Will my urinary problems get better?
    • What treatments are available?
    • What are the risks and side effects of treatments for urinary problems?
    • What can I do to help myself?
    • Where can I get pads and other products?

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    Problems After Prostate Cancer Treatment

    Many men get urinary problems as a side effect of their treatment. This is because prostate cancer treatment can damage the nerves and muscles that control when you urinate .

    If youre starting treatment for prostate cancer, ask your doctor about the possible side effects. Each treatment can cause different urinary problems. Your chances of getting each side effect will depend on the treatment youre having, and on whether or not you had urinary problems before starting treatment.

    If youve already had prostate cancer treatment and you have urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes to help manage them.

    Depending on the type of problems youre having, ways to manage them can include lifestyle changes, pelvic floor muscle exercises, bladder retraining, medicines or surgery. For practical tips read our How to manage urinary problems guide.

    Watch Paul’s story below for one man’s experience of managing urinary problems after prostate cancer treatment.

    How Can Hyperbaric Oxygen Therapy Speed Up Radiation Recovery

    Hyperbaric oxygen therapy makes it possible to minimize and even reverse your radiation symptoms. It uses powerful 100% oxygen at pressures above regular atmospheric pressure to stream oxygen through your bloodstream.

    The pressure of HBOT drives oxygen not just into the bloodstream, but also into lymph tissue, bone tissue, red blood cells, and other critical locations. Since oxygen is critical for all healing functions, HBOT can reduce cell death, relieve pain, stimulate new growth of blood vessels, and boost circulation.

    As a result, tissues damaged by radiation or suffering from nutrient deficiencies can quickly become revitalized and enhanced. The oxygenation that occurs during HBOT promotes cellular growth that combats the harmful effects of radiation therapy and helps you recover more efficiently.

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    Side Effects From Radiation

    Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.

    Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

    Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

    Stereotactic Body Radiation Therapy

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    This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

    SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.

    The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

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    Side Effects From Hormone Therapy

    Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.

    The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.

    Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.

    Proton Beam Radiation Therapy

    Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

    Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

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    Possible Side Effects Of Ebrt

    Some of the side effects from EBRT are the same as those from surgery, while others are different.

    Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device or gel is put between the rectum and the prostate before treatment to act like a spacer to lessen the amount of radiation that reaches the rectum.

    Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.

    Some men develop urinary incontinence after treatment, which means they cant control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often with radiation therapy than after surgery. The risk is low at first, but it goes up each year for several years after treatment.

    Intensity Modulated Radiation Therapy

    Prostate Cancer and the Role of PostOp Radiation

    IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

    Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

    A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.

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    Blood In Urine Experienced As Symptom Of Prostate Cancer

    Depending on the stage of the disease, patients with prostate cancer may experience symptoms related to urinary problems, including a slow or weak urinary stream or the need to urinate frequently , erectile dysfunction, pain in the hips, back, chest, or other areas from cancer that has spread to bones, weakness or numbness in the legs or feet. Blood in the urine or semen also is a symptom.

    Blood in urine is known as hematuria, and it can be related to a number of conditions, often not severe or consequential. But in the case of prostate cancer, it usually occurs in advanced stages of the disease and it should not be ignored. Instead of the normal pale yellow color of the urine, men may note it is pink, red, brownish-red, or tea-colored. In some cases, it may not be seen with naked eye, but the presence of red blood cells in urine can be detected in the lab.

    Blood in urine is associated with damage to the kidneys, where urine is created, or to a problem in another part of the urinary tract, including the ureters , the bladder , or the urethra . The tumor may press one of these structures, while blood in urine also may be a side effect of radiation therapy. Reporting blood in urine to a doctor may help readjust the treatment and improve patients quality of life.

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