This provides a very brief overview of side effects from radical prostate cancer treatments. Part of a larger online course.

1. Part of the “Enhancing Prostate Cancer Care” MOOC
Catherine Holborn
Senior Lecturer in Radiotherapy & Oncology
Sheffield Hallam University

2. Radical Prostatectomy
Erectile
Dysfunction
Rates vary. Function can improve over time (2-3 years post-op). For some men, this
may not occur. For many, function is never the same as pre-operatively.
Factors influencing recovery include:
•Pre-op potency
•Ability to spare (or not) neurovascular bundle
•Age
•Diabetes mellitus, hypertension, heart disease and cigarette smoking (negative
impact)
Penile shortening is also possible
Urinary
Incontinence
and
Dysfunction
Common effect immediately after surgery. Can range from a few drips to more
significant leaks. 'Stress' incontinence mostly (leaking during a cough, sneeze, lifting
objects, exercise etc...
Usually improves over time, most men notice an improvement after 3-6 months.
Older men are more likely to have problems. Equally, could actually improve pre-existing
problems e.g. caused by benign enlargement.
Bladder neck obstruction and urethral stricture are possible but not common.
Other Effects If the man is able to achieve an orgasm, then very little/no ejaculate will be produced
(dry orgasm)
The man will be infertile (lack of semen and PSA) - also occurs with radiotherapy
If pelvic lymph nodes are removed then leg oedema is possible.

3. External Beam Radiotherapy
Erectile
Dysfunction
Can take a number of years to develop. Reported to have less of an impact than surgery
BUT rates vary significantly. Pre-op potency along with other factors (see previous slide)
will affect the risk of this developing.
Adjuvant Androgen Deprivation therapy (ADT) will have a big impact due to a loss of
libido.
Urinary
Incontinence
and
Dysfunction
It is quite rare for men to experience incontinence in the long term. Previous Trans-
Urethral Resection of the Prostate (TURP) increases the risk.
The most common type is 'urge' incontinence (increased frequency, overwhelming and
sudden need to pass urine). This can be a particular problem 'during' treatment when
men are asked to maintain a full bladder when they receive their treatment each day.
Bowel
Dysfunction
Inflammation can cause a change in bowel habit (acute and longer term).
Much less common with modern techniques that spare the rectum e.g. IMRT and IGRT.
A small number of men may have long term/permanent problems (radiation-induced
enteropathy)
Possible symptoms include rectal urgency, increased frequency, faecal incontinence,
pain, bleeding and blood in the stools.
Other Effects Fatigue is a commonly experienced side effect during radiotherapy. Likely to be multi-faceted
and exacerbated if the man is receiving ADT.
A mild skin reaction is possible (reddening of the skin). Some men 'may' experience skin
soreness in particular between the buttocks.
There is a very small risk that it may cause a secondary cancer e.g. colorectal cancer.

4. Brachytherapy
Erectile
Dysfunction
Risk, time to development and influencing factors are similar to those for external
beam RT.
Urinary
Incontinence
and
Dysfunction
Haematuria is a common side effect in the short term.
Incontinence is rare but more common (stress incontinence) if a man has had previous
TURP.
More common issues are those of urinary obstruction and irritation caused by
inflammation of the prostate and urethra (modern planning techniques can better
avoid the urethra).
Men with existing urinary problems are most affected. External beam RT or surgery
may be a better option for these men.
Other Effects Short term effects (first couple of weeks) can include, bruising around the perineum,
spreading to the upper thighs and penis.
Pain or discomfort spreading to the penis tip.
Long term bowel problems (inflammation, bleeding, change in habit) are uncommon,
but possible.

5. You will be able to explore the impact of these side effects on
general wellbeing and quality of life in week 4 of the MOOC.

6. You will be able to explore the impact of these side effects on
general wellbeing and quality of life in week 4 of the MOOC.