Prostate Cancer Treatment Side Effects

Prostate Cancer Treatment Side Effects: Learn How to Become Prostate Cancer Free
Content contributed by R. Alex Hsi, M.D.
Peninsula Cancer Center

Understand Prostate Cancer Treatment Side Effects Before You Select A Treatment

Understand Prostate Cancer Treatment Side Effects When Selecting A Treatment
Prostate cancer treatment side effects can vary greatly from little to none, or create life time issues. Studying what treatments cause what side effects should be part of your treatment decision. Consenting to treatment means you understand the nature of the treatment, risks, benefits and alternatives.
YOUR BODY……… YOUR TESTS…….. YOUR TREATMENT

Treatment or the combination of treatments in advanced cases can lead to a wide range of side effects. Prostate cancer treatment side effects include erectile dysfunction, incontinence, urinary issues, diarrhea, hot flashes, weight gain, loss of muscle, vomiting and hair loss. There are short term prostate cancer treatment side effects that subside over time, as well as long term side effects that can last for years.
Prostate Cancer Treatment Side Effects: Which Prostate Cancer Treatments Cause Which Side Effects

What are the Prostate Cancer Treatment Side Effects of a Prostatectomy?

The primary prostate cancer treatment side effects after a radical prostatectomy are incontinence and erectile dysfunction. These side effects are a product of the location of the prostate and the type of surgery performed. The prostate gland lies deep within the pelvis behind the pubic bone and in front of the rectum. The urinary bladder lies just above the prostate, the urinary sphincter control muscle is located just below it, and the erectile nerves lie just outside the prostate on either side. A patient’s age and overall health also influence the potential risks of radical prostatectomy just as it does with any major operation. Such risks include cardiac or pulmonary events, infections, blood clots, or injuries to structures around the prostate.

PROCEDURE SHORT TERM LONG TERM
PROSTATECTOMY

Radical
Retropubic
Prostatectomy
(RRP)

OR

Robotic
Assisted
Laparoscopic
Radical
Prostatectomy
(RALP)


Following surgery, all men will have some urinary leakage. A good amount of bladder control is often regained within 12 weeks and continues to improve over 12 months. Multiple studies have shown that there is often a several month interval before a patient recovers normal erections, even with bilateral nerve-sparing surgery. Advantage to the RALP technique are reduced risk of intra-operative bleeding and shorten hospital stay.

Less than five percent of patients have severe incontinence which is persistent. Mild incontinence when coughing, laughing or sneezing may persist in up to an additional 5 percent of patients. With RALP, approximately 90% have good urinary control and require no urinary leak protection after a period of twelve months. Men who have “normal” pre-operative sexual function have a 72% likelihood of having erections that are adequate for penetration following a bilateral nerve-sparing operation. A quarter of these patients require PDE-5 inhibitors in order to reach their maximal level of potency. If a unilateral nerve-sparing procedure is performed, 38% of men will have erections that are adequate for sexual activity. Less than 1 in 10 men who undergo a non-nerve sparing procedure will have erections adequate for intercourse after surgery. In patients that are unable to obtain satisfactory erections after surgery, additional procedures such as penile implants are available to help restore erections and sexual function.

What are the Prostate Cancer Treatment Side Effects from Radiation?

R. Alex Hsi, MD, Radiation Oncologist describes a breakthrough method to reduce side effects when prostate cancer is treated with radiation.
RADIATION THERAPY
Prostate cancer treatment side effects of radiation therapy can be divided into early (occurring during or shortly after treatment) and late (occurring months or years after treatment) effects. These effects are related to the organs around the prostate. The bladder and rectum sit just above and just behind the prostate, respectively.

PROCEDURE SHORT TERM LONG TERM
External Beam Radiation Typical early effects include bladder and rectal irritative symptoms such as frequency and urgency. Patients may also notice a weaker urinary stream, getting up more often to urinate at night (nocturia), and loose or irregular bowel movements. These effects may be noticed about half way through the course of treatment and slowly increase in intensity until the end of treatment. They usually resolve within a few weeks after completion of treatment. Late effects are much less common than early effects, but can be more serious and long lasting. Urinary stricture or incontinence are rare, but can occur particularly in patients who have significant urinary problems prior to treatment. Loss of potency (ability to have an erection) can occur and is directly related to the patient’s age and erectile function prior to treatment. Medications known as PDE-5 inhibitors are often helpful in improving this problem. Rectal inflammation, called proctitis, can occur, but infrequently becomes serious enough to require treatment.
Prostate Seed Brachytherapy
or
High Dose Rate Radiation
Immediately after the procedure, patients may have some perineal discomfort and even some bruising for a few days. Patients often experience increased urinary frequency, urgency, weak stream and nighttime urination. These effects are at their greatest for 4-6 weeks after brachytherapy and will dissipate over the following 3-6 months. Late effects are much less common than early effects, but can be more serious and long lasting. Urinary stricture or incontinence are rare, but can occur particularly in patients who have significant urinary problems prior to treatment. Loss of potency (ability to have an erection) can occur and is directly related to the patient’s age and erectile function prior to treatment. Rectal inflammation, called proctitis, can occur, but infrequently becomes serious enough to require treatment.

What Are the Treatment Side Effects After CRYO, HIFU, CHEMO, and Hormone Therapy?

PROCEDURE SIDE EFFECTS
Cryotherapy Compared to surgery or radiation therapy, less data is available regarding the long- term (greater than 10 year) side effects and effectiveness of cryotherapy. As a result, it is common for patients to pursue this modality only if they are not good candidates for radiation therapy or surgery.
HIFU HIFU or High Intensity Focus Ultrasound procedure may be result in impotence, incontinence, urinary frequency and burning, or rectal wall injury.
Chemotherapy Chemotherapy can cause anemia, increased risk of infection and easy bruising (from low red cells, white cells and platelets, respectively), hair loss, mouth sores, nausea, vomiting and diarrhea.
ADT or Hormone Therapy Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy can cause Hot flashes, reduced sexual desire, impotence, weight gain, breast enlargement, loss of muscle, fatigue, osteoporosis, or anemia.

Cardiac Health Needs to Be Considered Before Hormone Therapy


Edward Weber, M.D. Medical Oncologist, describes the side effects of cardiac complications when receiving Androgen Deprivation Therapy, ADT, also known as Hormone Therapy, for treatment of Prostate Cancer. ADT is used to reduce the production of testosterone needed for the growth of prostate cancer cells. But ADT can have cardiac complications, especially on men with a history of heart disease.

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