Radiation Side Effects

Hi there,

Long term effects are dispersed, this means that they become more and more individual and difficult to predict.
Both surgery and radiation affect the urinary sphincters.
Surgery tends to result in short term leakage that improves with time and then declines with age.
Radiation has complex effects, it may become hard to pee, then easier, then hard again, but it is unpredictable.
Surgery tends to have a drastic effect on erectile ability, but things may get better.
Radiation may have less effects initially but things may get worse due to damage to the nerves long term.
More radiation increases the risk of bowel and bladder cancer, damage to the tops of the leg bones, etc.
This is a hard one to call, some men pass through unharmed, while others have short or long term effects.

Best wishes,

Georges

Hi,

My personal response from a person who has had surgery.

Old Salt said:

Few reliable data

Studies that report side effects that occur after 10-20 years are few and far between. 

Not surprising, really, considering that not many academic types follow patients for that long. Moreover, the number of patients that are reporting back will keep dwindling. 

There are many studies reporting side effects from radiation that occur after a few years (1-10). 

Here are the results from one such study:

Acute and Late Urinary Toxicity following Radiation in Men With an Intact Prostate Gland or after a Radical Prostatectomy: A Secondary Analysis of RTOG 94-08 and 96-01 (nih.gov)

Results

Grade≥2 acute urinary toxicity was significantly higher after primary prostatic radiation compared to post-prostatectomy radiation (30.8% versus 14.0%; p<0.001), but acute grade≥3 toxicity did not differ (3.8% versus 2.7%; p=0.54). After adjusting for age, primary radiation resulted in significantly higher grade≥2 acute urinary toxicity (OR:3.72; 95% CI:1.65–8.37; p=0.02). With median follow-up of 7.1 years, late urinary toxicity was not significantly different with primary versus post-prostatectomy radiation (5-year Grade≥2: 16.7% versus 18.3%; p=0.65; Grade≥3: 6.0% versus 3.3%; p=0.24).

 

PS: I find the previous posts all relevant.

If you dig into this study it involved patients treated mostly in the 1990's, before any of the current radiation devices were deployed.

We all know tha radiation was inaccurate and caused toxicities in that period. I consider the modern age of RT to start from about 2005.

Unfortunately, studies like this one are STILL being distributrd by urologist offices to steer men towards surgery.

Modern beam radiation (IMRT, SBRT, and protons) have very impressive ten year studies. In fact, I have never seen any study that showed that surgery could match the non-recurrence results of SBRT/Cyberknife. Not even close.

Hi Rob,

I doubt that you will receive many answers/comments to your inquire regarding the actual side effects experienced by survivors in PCa radiotherapies. Many guys here prefer to comment on the scale of the risks you may confront in case you choose RP or RT because the results from any therapy cannot be used in a decision process. Each case is unique to the holder and the effects from a certain type of therapy may be experienced differently among the survivors.

Accordingly, the results from studies done to verify the Acute Toxicity experienced by patients are also not practicable to be used in a decision process. Your thoughts may be influenced by those studies but these come from a wide variety of cases with a wide variety of variables (age, radiation dose, treated field, type of Gleason, etc). In other words, in PCa there is not what we expect as one therapy treats all.

In my salvage radiation treatment of 2006 (IMRT), I experienced diarrhea during the first three months post RT (grade 2 AE)as short term side effects. All other effects were asymptomatic therefore judged as grade 1 AE. At 5 years mile stone, I experienced blood in stool which from a colonoscopy was diagnosed as diverticulitis (a natural way of clean the colon done by our body), but the same image study verified existing radiation proctitis/cystitis which could in fact be the cause of the bleeding (grade 2 AE). In 2018 I had blood in urine and a cystoscopy reveled radiation cystitis in the urethra considered to be a RT late side effect development from the initial asymptomatic experience of 2006 (grade 1 to grade 2 AE).

I never experienced urinary or fecal incontinence along my 21 years as a survivor, respectively from surgery (2000) and radiotherapy (2006) but recently I experience a shorter time for holding the urge to urinate or stool discharging. This started to affect my natural way of life. In 2019 I was negated a oligometastatic treatment due to the presence of radiation cystitis in the area where malignancy was identified in a PET scan. My doctor (uro-oncologist) is a experienced HOT (hyperbaric oxygen treatment) therapist and commented that the malignancy could be soft tissue affected with RT cystitis, which in fact requires HOT if inflammation develops and becomes nasty.
In regards to the above, most probably I will experience in the future radiation grade 3 AE which could be classified as RT late side effects.

Along the years as a member in this and other forums, I read reports from guys that had nasty experiences with PCa radiotherapy. The worse cases are fistulas that drastically change the quality of life of the patient. One guy in particular was in need of bladder and colon surgery as a result from a PCa prime IMRT in 2009. Some other cases were from guys that had ulcerative colitis (asymptomatic) without knowing and did radiotherapy which condition is supposed to be prohibitive to RT decisions.

Surely surgery has its pitfalls too and the ED risk is hard to be accepted by young patients. If you choose RT you better investigate further doing a colonoscopy before deciding.

You doing well in investigating further.

Best wishes

VGama 

experiences with urethra issues are all negative in RP or RT

Hi there,

I would consider the short term side effects more than the long term effects.
The first are moderately predictable insofar as you will suffer from at least some of them unless you are very lucky.
The long term ones are less predictable, and you may dodge them all.
As JM Keynes said 'In the long run we are all dead'

Best wishes,

Georges