Urethral Stricture As A Side Effect Of Radiation For Prostate Cancer
After radiation therapy to treat prostate cancer with external beam radiation including proton beam therapy and/or radioactive seed implants, the most common location of a urethral stricture is the membranous urethra. This is the part of the urethra just under the prostate and the urethra in this area is surrounded by a muscle called the external urethral sphincter, which is one of the sources of continence. An illustration of the urethra showing the location of this part of the urethra is found here.
When patients are referred to the Center for Reconstructive Urology with blockage of urine flow after treatment for prostate cancer, they often are not clearly aware of their specific diagnosis with regard to the urethral stricture location and stricture length, even if they underwent prior treatment . If they only had a cystoscopy it is not possible to know the length of the stricture. If imaging was performed and that imaging did not include both a film during injection of contrast and during voiding , there cant be a definitive diagnosis.
We evaluate the urethra using both cystoscopy and high definition accurate urethral imaging to first determine the exact stricture length and location. This comes before a discussion of all options .
With the gentle injection of X-ray contrast to fill the bladder , we can then obtain a film during urination called a voiding cystourethrogram
Talking About Bowel Problems With Your Doctor
Bowel problems can be embarrassing and life changing. Because of this, its common for men to avoid talking about these struggles with their healthcare team or partners. By not talking about these issues, feelings of fear or inadequacy may build up and cause significant mental, emotional, or physical complications.
For this reason, it is critical to talk with your doctor about potential treatment options that may be right for you, or for specific tips on how to manage what is going on. How much you share about your bowel struggles is completely up to you, however, enlisting the support of an intimate partner, spouse, or close confidant may help ease the burden and set expectations or plans to be followed in the event that you need help managing your bowel struggles outside of your home.
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What Are The Prostate Cancer Treatment Side Effects Of A Prostatectomy
The primary prostate cancer treatment side effects after a radical prostatectomy are incontinence and erectile dysfunction. These side effects are a product of the location of the prostate and the type of surgery performed. The prostate gland lies deep within the pelvis behind the pubic bone and in front of the rectum. The urinary bladder lies just above the prostate, the urinary sphincter control muscle is located just below it, and the erectile nerves lie just outside the prostate on either side. A patients age and overall health also influence the potential risks of radical prostatectomy just as it does with any major operation. Such risks include cardiac or pulmonary events, infections, blood clots, or injuries to structures around the prostate.
SHORT TERM
Following surgery, all men will have some urinary leakage. A good amount of bladder control is often regained within 12 weeks and continues to improve over 12 months. Multiple studies have shown that there is often a several month interval before a patient recovers normal erections, even with bilateral nerve-sparing surgery. Advantages to the Robot Assisted Laparoscopic Prostatectomy technique are a reduced risk of intra-operative bleeding and a shortened hospital stay.
LONG TERM
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Stereotactic Body Radiation Therapy
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.
What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease and to the individual person. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are the only center in the world to do MRI-based treatment planning. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. This allows us to make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
For more advanced disease, we have ongoing studies in which we combine novel hormonal therapy agents with radiation to achieve better results. Even the way we follow our patients after treatment is unique, with carefully sequenced MRI checks that give us opportunities to monitor patients extremely closely.
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How To Cope With Digestive Issues
Chemotherapy and radiation therapy can both cause nausea, vomiting and diarrhea. There are several medications, however, that can prevent and alleviate these digestive concerns. Additionally, making certain dietary changes can help ensure that you get the nutrients you need when dealing with digestive issues.
Frequent Or Loose Poo
Your bowel movements might be looser or more frequent than before your treatment.
You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help. Your doctor or nurse can prescribe these for you, talk to your doctor before taking these.
You might find that you need to avoid high fibre foods. Although we normally think that a high fibre diet is the most healthy, it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .
Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.
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Radiation Therapy: What It Is
This therapy, also known as radiotherapy, is a cancer treatment procedure that uses high doses of radiation to kill cancerous cells and shrink the tumor as well. At low doses, this procedure is used as an x-ray.
*All individuals are unique. Your results can and will vary.
This therapy can be internal or external or both form. For external beam, a machine that is outside your body aims at the cancerous cells. For internal therapy, the radiations are placed inside your body inside or near the cancer.
For radiotherapy for prostate cancer, high-energy rays are used to kill the cancer cells. This treatment procedure does not cause pain. However, it may result in various side effects that might cause pain and make you feel uncomfortable. The good thing is that there are numerous ways to manage radiotherapy side effects with the help of your radiation oncologist.
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
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Bowel Changes After Pelvic Radiotherapy
Bowel changes caused by pelvic radiotherapy can show as a variety of symptoms. These may be uncomfortable and inconvenient, or even painful and distressing.
We hope the information on this page helps explain why you might have bowel symptoms and how to manage them. We are also here if you need some extra support or arent sure where to start.
What Are Potential Side Effects
Typically, prostate-cancer patients tolerate radiation well.
During the first several weeks, side effects are minimal.
In the following weeks, you may begin to experience a few changes, including irritative urinary and bowel symptoms.
We manage those with changes to diet, or medication, says Dr. Yu. We have helpful clinical nutritionists who can help ease side effects related to treatment, and if a patient has severe side effects, its possible to suspend treatment for a week.
There is a small risk of a major medical problem, such as rectal bleeding, after radiation. In recent years, the precision of radiotherapy has helped to reduce such complications. Doctors track their patients regularly after treatment in order to catch any serious symptoms early.
Our urology group is also exploring focal salvage therapies that may be able to address residual cancer that returns after radiation treatment, says Dr. Yu.
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How To Manage Fatigue
Many men feel exceptionally tired and forgetful during prostate cancer treatment. Its important to give yourself plenty of time to rest, but it can also be helpful to stay as active as possible. A counselor or social worker can provide you with tips for dealing with mental exhaustion and depression, which can compound the effects of physical fatigue if left unaddressed.
Will My Faecal Incontinence Get Better
There is no doubt that your poo related problems are having a significant impact on your life and mental strength. You may have noticed it negatively affecting your personal relationships, social life and desire to do the things you love. On top of this, much of your time getting out of the house will be spent with concern and meticulous planning around toilet visits. These factors can quickly take their toll on your quality of life and others around you, which makes it much more important to best prepare yourself and minimise its impact.
Unfortunately there is a degree of uncertainty regarding your ability to recover normal bowel control after radiotherapy due to the complexity of side effects and the reaction from each individual. With the research showing that symptoms can begin and persist long after treatment, it can seem like a doom and gloom scenario. Despite the scary statistics, you need to take a position of strength and control the things you can to combat faecal incontinence. Fortunately, the positives are that radiotherapy techniques are becoming more effective at treating the cancer and reducing its side effects.
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What Is Radiation Recall
Radiation recall is a rash that looks like a severe sunburn. It is rare and happens when certain types of chemotherapy are given during or soon after external-beam radiation therapy.
The rash appears on the part of the body that received radiation. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.
Typically, these side effects start within days or weeks of radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals before continuing chemotherapy.
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Disabled Toilets And Emergency Access
As some shops, restaurants and leisure venues reopen after COVID-19 restrictions are lifted, its worth remembering that many of these will have customer toilets available.
There are a number of toilet cards you can apply for. The cards discreetly explain that you have a medical condition that means you need to use the toilet urgently. You can order a free toilet card from:
You can also buy a Radar Key from Disability Rights UK. This master key is part of the National Key Scheme . It gives you access to more than 9,000 locked disabled toilets around the country, including in shopping centres, department stores, pubs and cafes.
Changing Places also have a list of accessible toilets and rooms that can be used if you need a more private space. Some of them are free to access and some of them need a Radar Key. You can search for your nearest Changing Places toilet to find out more about it.
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How To Manage Urinary And Bowel Dysfunction
Its common to experience urinary dysfunction, bowel dysfunction or both after receiving radiation therapy to the prostate gland. Medication is usually the first treatment recommended for these issues, although there are also injections and surgical procedures that can be used to address these side effects should they persist.
Not Sleeping Well Causes Fatigue
Some people with cancer are not able to get enough sleep. The following problems related to sleep may cause fatigue:
- Waking up during the night.
- Going to sleep at different times every night.
- Sleeping duringthe day and less at night.
- Being inactive during the day.
- The time of day that cancer treatment is given.
Poor sleep affects people in different ways. For example, the time of day that fatigue is worse may be different. Some people with cancer who have trouble sleeping may feel more fatigue in the morning. Others may have severe fatigue in both the morning and the evening. People with cancer who are inactive during the day, have restless sleep, or who have obesity may have higher levels of fatigue.
Even in people with cancer who have poor sleep, fixing sleep problems does not always improve fatigue. A lack of sleep may not be the cause of the fatigue. See the PDQ summary on Sleep Disorders for more information.
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Practical Management Of Bowel Changes
While lifestyle changes and medical treatments can help to improve your symptoms, we know that bowel concerns can be really difficult to manage. This is especially true when you are away from home. Not having easy access to a toilet can be a huge source of anxiety when you have bowel changes. Its always worth checking where the nearest toilets are when youre out, to reassure yourself and avoid any accidents.
Managing Constipation Diarrhea And Other Bowel Problems
In some instances, normal bowel functioning and control will be regained after treatment and post-recovery. But if this process isnt occurring as fast as anticipated, or isnt happening at all, there are a few interventions and lifestyle changes that can help manage bowel problems. Several of these options include:
- Anti-diarrheal agents
- Avoiding foods that may irritate the digestive system
- Creating a bowel movement schedule and retraining your bowels
In rare instances, it may be possible to have surgery for bowel incontinence, including anal sphincteroplasty or anal sphincter repair, depending on the predicted underlying cause of the incontinence.1-3 Treating bowel-related difficulties can be tricky, and will largely depend on the exact symptoms you are experiencing.
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Long Term Side Effects Of External Radiotherapy
You might have long term side effects after having external radiotherapy for prostate cancer, such as erection problems . Tell your doctor or nurse if you have any of these problems, they can help you with them.
Most side effects gradually go away in the weeks or months after treatment. But long term side effects can continue. Or you might notice that they begin months or years later.
Swelling Bruising Or Tenderness Of The Scrotum
Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.
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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.
Spaceoar Hydrogel Reduces Side Effects Of Prostate Cancer Radiation Therapy
While radiation treatment for prostate cancer has become much more precise over the years, the organs location immediately next to the rectal wall can expose the rectum to high dose radiation, which can lead to disruption in bowel function for some patients.
A new method for reducing these short- and long-term side effects is SpaceOar hydrogel, now available at Fox Chase.
In a minimally invasive outpatient procedure, the two liquid components of SpaceOAR hydrogel are injected through the peritoneum into the space between the rectal wall and the prostate by a urologist. The procedure is done under anesthesia with ultrasound guidance.
The resulting interaction between the two fluids creates a temporary and absorbable gel spacer that is primarily made of water. Hydrogels have been used in other implants such as surgical sealants used in the eye, brain and spine.
The OAR in SpaceOAR stands for Organ At Risk, referring to the rectum.
The position of the prostate poses particular challenges for the higher doses of radiation treatment required for this type of cancer, Fox Chase radiation oncologist Mark Hallman MD, PhD said. The posterior prostate lies right on top of the interior rectal wall and this puts the rectum at increased risk.
SpaceOAR was approved as a medical device by the FDA in 2015 and Fox Chase is among the first in the Philadelphia area to offer it.
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