Side effects of Prostate cancer radiotherapy
Radiotherapy to the prostate can lead to some side effects, like diarrhea (loose or watery stools) and increased frequency of urination.
The testicles
The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.
Image of the testicles (cruk)
Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.
The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.
Testosterone:
The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:- A deeper voice
- Facial hair growth
- Increased muscle mass
- The ability to achieve an erection
- Male sexual drive (libido)
Where does testicular cancer start:
The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins. Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:- Seminoma
- Non-seminoma
These side effects typically start a week or two after the radiotherapy begins. They tend to worsen during the course of treatment and for a couple of weeks after it ends. However, they usually start to improve about two weeks after finishing treatment.
Everyone’s experience is different, and side effects can vary from person to person. You might not experience all of the mentioned effects.
Tiredness and weakness:
You may experience fatigue during your treatment, which often increases as the treatment progresses. You might also feel weak and low on energy. It’s important to rest when you need to.
This tiredness can persist for several weeks after the treatment concludes but generally improves over time.
There are several ways to manage and reduce fatigue, including exercise. Some studies have indicated that gentle exercise can boost your energy levels. It’s crucial to balance exercise with adequate rest.
Sore skin in the treatment area:
Your skin in the treatment area may become sore, red, or darker. These tips can help:
– Opt for loose-fitting underwear and clothing. Natural fabrics are usually more comfortable than synthetic ones.
– Wash the area gently each day with mild, unscented soap and warm or cool water. Baby soap or liquid baby wash are good options, but check with your radiotherapy team first.
– Pat your skin dry with a soft towel instead of rubbing, which can cause irritation.
– Avoid using scented lotions on the area. Stick to creams or dressings recommended by your specialist or radiographer.
– Steer clear of talcum powder, as it can contain tiny metal particles that could worsen the soreness.
Inform the nurse or radiographer at your treatment centre if you see any redness or experience soreness. They can provide creams to help alleviate these symptoms.
Loss of Pubic hair:
Radiotherapy can lead to hair loss in the area being treated. This hair loss might be uneven rather than total. Hair can regrow, but it might not return completely and could take several months to do so.
Problems passing urine:
You might experience:
– feeling like you need to urinate frequently, but only a small amount comes out
– sensations similar to a bladder infection (cystitis)
– a burning sensation when urinating
– a weak urine stream
– difficulty in passing urine
It’s important to drink plenty of water. Some people believe cranberry juice helps with bladder issues, but it isn’t effective for those caused by radiation.
Bladder inflammation usually improves a few weeks after your treatment ends.
Inform your doctor if you have pain while urinating. It could indicate an infection, and they might have you do a urine test (Mid Stream Urine). Antibiotics might be needed for treatment.
Diarrhea:
If you experience diarrhea, let your doctor, nurse, or radiographer know right away. They can provide medications to alleviate it.
Stay well-hydrated by drinking plenty of fluids.
Ask your nurse about creams that can soothe the skin around your rectum. Severe diarrhea can cause this area to become very sore and may even lead to skin breaks.
Possible long term side effects:
Most side effects gradually diminish within weeks or months after treatment ends. However, some side effects may persist or emerge months or even years later, such as difficulties with achieving an erection.
Each person experiences side effects differently, and you may not encounter all the ones mentioned. Be sure to inform your doctor or nurse if you experience any of these issues. They can assist you in managing and mitigating the effects.
About side effects:
Before starting treatment, your doctor will discuss the potential side effects with you. However, they can’t predict exactly which side effects you might experience. Some people are more prone to certain side effects than others.
Your risk of side effects increases if you receive both brachytherapy and external radiotherapy.
Problems passing urine and leakage of urine:
After radiotherapy, you might have trouble passing urine. It can gradually become more difficult over several weeks or months because the treatment can narrow the urethra, the tube from the bladder to the penis. This narrowing is called a urethral stricture.
If you have difficulty urinating, you might need a minor surgery to widen the urethra. Talk to your doctor if you find it hard to pass urine.
In rare cases, some men can’t pass urine at all. If this happens, contact your doctor immediately.
Nearly 50% of men who undergo radical radiotherapy experience some urine leakage after 6 years. Your doctor or nurse can refer you to an incontinence clinic for help with exercises, bladder training, and medications.
In rare cases, some men may lose control of their urine completely. If this occurs, you may need a catheter to drain the urine into a bag.
Difficulty getting an erection:
Radiotherapy can harm the nerves that help with erections.
Your ability to get and maintain an erection after radiotherapy depends on:
– Your age (erection issues are less likely if you are under 65)
– Any existing health conditions
– Whether you had erection problems before treatment
– If you have hormone therapy before or after radiotherapy
– If you have both internal and external radiotherapy
Tell your doctor or specialist nurse right away if you have erection problems. They can refer you to a specialist for help.
Early treatment with medications like sildenafil (Viagra) might help you get and keep erections.
Problems with your bowels and back passage:
Your bowel movements might become looser or more frequent after treatment. You may need to take anti-diarrhea medicine like loperamide (Imodium) or bulking agents like Fybogel to help.
Avoiding high-fiber foods, such as certain vegetables, beans, and lentils, can help manage long-term diarrhea.
Inflammation of the rectum (proctitis) can also be a side effect, causing you to feel like you need to pass a bowel movement even when you don’t. You might experience bleeding or a slimy mucus discharge from your rectum.
If you have any of these side effects, talk to your doctor or specialist nurse. They can refer you to a specialist team to help manage these effects.
Swollen legs or scrotum:
You might experience swelling in your legs or the scrotum (the skin around the testicles). This swelling, called lymphoedema (pronounced lim-fo-dee-ma), occurs when the lymph channels that drain fluid from the legs are damaged by radiotherapy. It can be uncomfortable.
There are several ways to reduce the risk of lymphoedema. Early treatment can help lessen the swelling and prevent it from getting worse.
A second cancer:
A few men may develop bladder or rectal cancer years after having radiotherapy for prostate cancer.
It’s important to see your doctor if you notice blood in your urine or stool, or if your bowel habits change.
Problem with bones:
Radiotherapy can weaken the bones in the pelvic area by damaging bone cells and reducing blood flow. This is called avascular necrosis and can cause pain and difficulty walking or climbing stairs.
Your doctor will monitor your bone health, possibly using a DEXA scan. They may recommend painkillers, walking aids, or medications like bisphosphonates to strengthen the bones and reduce pain.
Sometimes, small cracks can develop in the pelvic bones years after treatment. These pelvic insufficiency fractures are more common in older people with weakened bones (osteoporosis) and those on hormone therapies or steroids.
If you experience bone pain, especially if it worsens with movement and eases with rest, talk to your doctor. They might order x-rays, a CT scan, or an MRI to check for fractures.
Low levels of Vitamin B12:
After pelvic radiotherapy, you might have low vitamin B12 levels, known as a vitamin B12 deficiency. This happens because the radiotherapy can prevent your digestive system from absorbing vitamin B12 from your food, even if you eat a balanced diet.
A deficiency in B12 can cause anemia, leading to symptoms like weakness, diarrhea, and numbness or tingling in your hands and feet.
If you notice any of these symptoms, it’s important to see your doctor for help.
Daignosis
If you have any symptoms, your first step is usually to visit your GP. They will discuss your symptoms with you and conduct an examination. Based on their findings,
Treatment options
A team of healthcare professionals (multidisciplinary team) will determine your treatment plan. Most people undergo surgery to remove the affected