Potential Complications of Radiation Therapy for Prostate Cancer

This article reviewed the possible complications that can occur after radiation therapy for prostate cancer.

Radiation therapy (RT) is usually given as part of prostate cancer management. RT improves the prognosis of prostate cancer by limiting the rate of recurrence (return of cancer). In early stages, RT can even cure cancer, as an alternative to surgery. Recent advances in RT allow very precise delivery of radiation and in higher doses than before. This leads to better cancer-fighting effects. Commonly used methods of RT include external beam radiation, brachytherapy and newer focused approaches.

However, despite its advantages, RT can have long-term side effects due to irradiation of other organs around the prostate. The rectum (the end part of the large intestine which sits behind the prostate) is most commonly affected.

This paper reviewed articles published in the medical literature (between 1999 and 2010), highlighting potential side effects of RT and their causes.

The main conclusions:

• Side effects of RT depend on the technique used to deliver the radiation. Fewer problems were encountered with newer procedures which used focused radiation to the prostate, with limited exposure of the rectum.
• Regardless of the type of RT, the most reported side effects are gastro-intestinal (GI), which include diarrhea, painful bowel movements, and rectal bleeding. These occurred more often in older men, those who had prior abdominal surgery, parallel hormonal therapy, or inflammatory bowel disease.
• The most common urinary side effect was radiation urethritis (inflammation of the urethra, the tube which carries urine from the bladder to the penis. Urinary retention and incontinence were less common. These were more frequent in men with previous urinary problems, or transurethral resection of the prostate (TURP).
• Erectile dysfunction (inability to obtain or maintain erection) was not a specific side effect of RT and usually occurred in patients with previous sexual problems.

An important limitation of this article is the non-uniform definitions of side effects used in the different trials reviewed. Also the baseline health status of trial subjects as well as additional treatments given (e.g. hormone therapy) were not evenly known.