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 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 use 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 is 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. This information shouldn't color your thinking about choosing radiation, especially since the surveillance methods for these types of cancers 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, 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 have 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, but generally will dissipate within 6-8 weeks after the treatment is finished. There can be some local soreness around the area of the rectum, or with urinary functions - some burning discomfort. Occasionally it's 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 9 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 scared, 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. And this can be very bothersome and 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.

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