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Urinary Problems After Radiation For Prostate Cancer

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If Treatment Does Not Work

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

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

Radiopharmaceuticals That Target Psma

Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.

Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.

This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.

This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.

Possible side effects

Some of the more common side effects of this drug include:

This drug can lower blood cell counts:

  • A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
  • A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
  • A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.

This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.

How Long Does It Take To Recover From Radiation Treatment

Theres no doubt radiation therapy can make the difference between life and death for cancer patients, but unfortunately it often comes at a cost.

Radiation therapy is associated with harsh side effects, many of which dont emerge until months or years after treatment. Acute side effects occur and disappear within 14 days of treatment, but long-term effects like bone degeneration, skin ulcers, and bladder irritation take much longer to manifest.

The complications of radiation therapy are frustrating, painful, and often embarrassing, but using ongoing therapy, such as hyperbaric oxygen therapy , can accelerate your radiation therapy recovery in a natural way and stop your symptoms from defining your quality of life.

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Surgery To Reconnect The Urethra

Different surgeries are done for different circumstances. For instance in some men the entire urethra through the prostate is scarred from radiation or attempts to clear the channel with scope procedures. In this circumstance the prostate needs to be removed and the urethra can be connected to the bladder .

In other patients, when the scarring is limited to the bottom of the prostate, a surgery through the perineum can be performed to remove the scar tissue and reconnect the urethra to the prostate .

Figures: Two examples of radiation damage from prostate cancer treatment causing a stricture or scar at the junction of the lower prostate and the urethra. 1) The first is from implanted brachy therapy seeds. 2) The second is from the combination of high dose brachytherapy and external beam radiotherapy.

Prostate Radiation Vs Robotic Prostatectomy

Urinary problems after prostate cancer treatment

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.

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Dealing With Prostate Cancer

Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.

Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

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. 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. We will often obtain next-generation imaging and do genomic testing. 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 one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. 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. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.

We 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.

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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.

Frequent Urination Burning With Urination And Difficulty Urinating

Which is Better – Surgery vs. Radiation for Prostate Cancer?

These are the most common complaints. Occasionally the urinary stream will weaken. Generally these symptoms are managed with medications to help the bladder function better or eliminate burning. Rarely, your doctor may order a urine test. Symptoms will resolve after the end of treatment. Contact your doctor if you see blood in your urine or if you are unable to urinate.

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Blood In Urine After Radiation For Prostate Cancer

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
  • 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 .

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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.

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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 Knifeî, X-Knifeî, CyberKnifeî, and Clinacî.

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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Urinary Frequency And Urgency

Reduced Effects of Radiation for Prostate Cancer Treatment  Doctors ...

Some men find they need to urinate more often after having radiotherapy , or get a sudden urge thats hard to ignore . You may also need to urinate more often at night . It usually only lasts for a few months after radiotherapy, but if it happens, it might help to drink less in the two hours before you go to bed, and to avoid drinks that irritate the bladder

A small number of men leak urine before they can reach the toilet . This happens when the bladder muscles twitch and squeeze without you controlling them. This pushes urine out before youre ready.

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Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Management Of Urinary Dysfunction

Because the urinary symptoms following radiation therapy are irritative in nature, drugs that improve urinary flow and treat irritative bladder symptoms are commonly prescribed to all men following radiation therapy for at least a few weeks. They are gradually withdrawn as symptoms improve.In cases of persistent urinary incontinence, surgical procedures, including a sling that relieves pressure buildup in the abdomen or artificial sphincters provide long lasting results.

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Management Of Urinary Problems By Prostate Cancer Patients

There are numerous treatment options for patients with prostate cancer, including expectant management or active surveillance, surgery, radiation therapy, cryosurgery , hormone therapy, chemotherapy, vaccine treatment, and bone-directed treatment. These are expected to ease the urinary symptoms, but there are other techniques that can help. Pelvic floor exercises, also known as Kegel exercises strengthen the pelvic muscles, while patients are recommended to avoid drinking more than 2 qt daily, alcohol drinks, coffee, tea, or soda pop, or a lot of liquids in the evening.

Patients may also benefit from scheduling urination every three or four hours while awake even if they dont feel need to. In the cases of patients who are unable to fully empty their bladder, patients may try a technique of double voiding by relaxing for a while and urinating again. Discomfort may be reduced by making a clearer and quicker path to the bathroom, as well as by wearing clothes easier to remove like elastic waistbands or Velcro closures, and by keeping a urinal close to the bed. Other recommendations that may improve the patients health include quit smoking, and having a healthy diet and weight.

How Common Are Urinary Problems After Radiation Therapy

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

1 out of 3 men

About 1 out of 3 men report experiencing some kind of urinary issue during radiation therapy. Most often, these issues are short term and will resolve over time.

1 out of 5 men

About 1 out of 5 men experience urinary obstruction symptoms, which is slow or difficult urination.

You may also notice that with age, and especially if youâve had radiation therapy, the urge to urinate can get worse and sometimes lead to leakage .

If youâve only had radiation therapy, itâs very unlikely that youâll totally lose urine control when you cough, laugh or lift something heavy .

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Urinary Problems Experienced By Patients With Prostate Cancer

Patients who suffer from prostate cancer often experience urinary problems either due to the condition or to the treatment itself. The term urinary dysfunction encompasses both urinary incontinence, which can range from some leaking to complete loss of bladder control, and irritative voiding symptoms, including increased urinary frequency, increased urinary urgency, and pain upon urination. Obstruction of the bladder by an enlarged prostate is the typical reason for these symptoms initially however, after therapy, these symptoms are typically caused by damage to the nerves and muscles that control urinary control, explain the Prostate Cancer Foundation.

What Are The Side Effects Of External Beam Radiotherapy

Like all treatments for prostate cancer, radiotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Sometimes bowel, urinary and sexual problems after radiotherapy treatment are called pelvic radiation disease.

Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy. Most healthy cells recover so side effects may only last a few weeks or months. But some side effects can start months or years after treatment. These can sometimes become long-term problems. Before you start treatment, talk to your doctor, nurse or radiographer about the side effects. Knowing what to expect can help you deal with them.

If you have hormone therapy as well as radiotherapy, you may also get side effects from the hormone therapy. Read more about the side effects of hormone therapy and how you can manage them.

If youre having radiotherapy as a second treatment, and you still have side effects from your first treatment, then radiotherapy can make those side effects worse or last longer. It may also cause other side effects. The most common side effects of radiotherapy are described here.

Short-term side effects of radiotherapy

Urinary problems

Bowel problems

Skin irritation and hair loss

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When Is Radiation Therapy Used

There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:

  • As the first treatment of cancer, which is still confined to the prostate gland.
  • It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
  • After the reoccurrence of cancer in the area, it was before surgery.
  • To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.

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