Prostate cancer is common globally. While treatable, radiation therapy can lead to long-term side effects. Understanding these outcomes helps patients and families navigate treatment decisions and manage post-treatment life.
Understanding Radiation Therapy for Prostate Cancer
Radiation therapy uses high-energy rays to destroy prostate cancer cells. Two main types are used: External Beam Radiation Therapy (EBRT) and Brachytherapy. EBRT delivers radiation from a machine outside the body, directing beams precisely at the prostate.
Brachytherapy places radioactive sources directly into the prostate. These “seeds” emit radiation, delivering a high dose to the tumor while minimizing healthy tissue exposure.
The prostate’s location near the bladder, rectum, and sexual function nerves explains why radiation can affect these organs. Even with precise targeting, radiation can inadvertently reach these structures, causing side effects.
Impact on Urinary and Bowel Systems
Radiation therapy affects the urinary system due to its proximity to the bladder and urethra. Many experience increased urinary frequency and urgency, requiring more frequent and urgent urination. Nocturia, or waking multiple times at night to urinate, is common.
Urinary incontinence, from minor leakage to significant loss of bladder control, can develop years after treatment. Less common but severe complications include urethral strictures, a narrowing of the urethra that obstructs urine flow, and hematuria, or blood in the urine.
The bowel system is susceptible to long-term side effects because the rectum lies behind the prostate. Radiation proctitis, an inflammation of the rectal lining, can cause increased bowel movement frequency and urgency. Some experience rectal pain or discomfort, particularly during bowel movements.
Rectal bleeding, often bright red, is another complication of radiation proctitis. Changes in stool consistency, including softer stools or diarrhea, can persist after treatment.
Impact on Sexual Function
Erectile dysfunction (ED) is a common long-term side effect of prostate cancer radiation therapy. This condition, the inability to achieve or maintain an erection firm enough for sexual activity, affects a man’s quality of life.
ED onset after radiation therapy varies, with changes appearing gradually over months or years. Severity also varies, from mild difficulty to complete inability to achieve an erection.
Beyond ED, other aspects of sexual function can be affected, though less commonly. Some men might experience decreased libido, often influenced by psychological factors and well-being. Changes in ejaculatory function, such as reduced ejaculate volume or dry orgasm, can also occur due to radiation’s effect on seminal vesicles and ejaculatory ducts.
Other Notable Long-Term Side Effects
Persistent fatigue can affect individuals for months or years after radiation therapy. This fatigue is distinct from general tiredness and impacts daily activities and energy levels.
A rare long-term risk is secondary cancers in the irradiated area, such as bladder or rectal cancer. The risk is extremely low, estimated at less than 1%, manifesting many years, often decades, after treatment. This risk is balanced against the benefits of treating prostate cancer.
Lymphedema, swelling due to fluid buildup, can occur in the legs or genital area if pelvic lymph nodes were included in the radiation field. While less common when radiation targets the prostate, this can cause discomfort and impaired mobility.
Radiation can rarely affect bone density in the irradiated pelvic area, potentially increasing fracture risk. Bone health is usually monitored in individuals with other risk factors for bone weakening.
Strategies for Managing Long-Term Effects
Managing long-term side effects of prostate cancer radiation therapy involves a multifaceted approach. Medical interventions alleviate symptoms. Medications can manage urinary urgency and frequency, while phosphodiesterase-5 (PDE5) inhibitors are prescribed for erectile dysfunction.
For bowel issues, medications can regulate stool consistency and reduce inflammation. Lifestyle adjustments play a role in managing these effects. Dietary changes, such as increasing fiber and ensuring adequate hydration, can aid bowel regularity and reduce irritation.
Pelvic floor exercises, often guided by a physical therapist, can improve urinary incontinence by strengthening bladder control muscles. Physical therapy can address pelvic pain and improve pelvic function. Counseling or support groups can provide emotional support and coping strategies for sexual dysfunction and other quality-of-life changes.
Open communication with the healthcare team is important for effective management. Oncologists, urologists, and nurses can provide tailored advice, adjust treatment plans, and refer to other specialists. This collaborative approach ensures symptoms are addressed promptly and individuals receive comprehensive care for long-term well-being.