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Side Effects from the Treatment of Prostate Cancer
(Also see the section on radiation side effects to the abdomen here and rectum here). See nursing instruction sheets here. As noted in the picture below...the prostate is very close to some very sensitive structures like the  bladder, rectum and the urethra. Any of the types of treatment can have serious side effects, and patients need to consider whether any treatment is worth the risk. (In fact for slow growing cancers, i.e. with Gleason Scores of 2, 3 or 4, no treatment at all may be logical particularly in older patients or people with a short life expectancy, see the section on watchful waiting.)

A patient should not agree to any form of treatment until he has a clear understanding of the possible risks and side effects associated with the treatment and the likely effect it may have on his remaining life expectancy and quality of life. (RTOG side effects score: #1 and #2)

prostate_normal_mayo2.jpg (17797 bytes)

Most patients do well with minimal side effects, but some patients suffer very serious complications (including loss of bladder control (incontinence) or rectal damage.

In general, surgery (radical prostatectomy) has the highest risk of causing impotence or incontinence; external beam irradiation has the highest risk of rectal damage, and seed implants may have the lowest risk of side effects. For a comparison of side effects by the different treatments go here, here, here, here and here.

 A discussion of these can be found at the appropriate links:

Surgery (and comparisons) and summary, long tem side effects from surgery here

Side Effects with External Beam Irradiation
Side Effects of Seed Implants

There are also side effects from hormone therapy (go here, here and here).

More detailed information concerning impotence is found here,  and two long review articles here and here,
and for risk to pelvic bones go here.

A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy.
Lee. International Journal of Radiation Oncology*Biology*Physics, 2001;51:3 : 614-623
prostate_qol_lee.gif (11587 bytes) the graph shows that initially the quality of life falls (worsens) the most for surgery (RP or radical prostatectomy) and then seeds (IB or interstitial brachytherapy) and the least for external beam radiation (EBRT) but   most men recover so well that  by a year out their quality of life was the same!

in general most men treated with any of the three treatment options recover quite well and have a very good quality of life

Recent studies suggest that rectal amifostine may reduce radiation toxicity to the rectum (go here.)

Read the Side Effects Listed in the Consent  Form (below) from the most recent Radiation Therapy Oncology Group Study (RTOG P-0019)that combined external beam irradiation with a seed implant

"While on the study, you are at risk for these side effects. You should discuss these with the researcher and/or your regular doctor. There also may be other side effects that we cannot predict. Drugs may be given to make side effects less serious and uncomfortable. Many side effects go away shortly after the radiation therapy is stopped, but in some cases side effects can be serious or long-lasting or permanent."

Risks Associated with External Radiation Therapy

Very Likely
  Tanning or redness of skin in treatment area
  Rash, itching or peeling of skin
  Temporary hair loss in the treatment area
  Temporary fatigue, nausea or diarrhea
  Abdominal cramps or bladder irritation
Less Likely, But Serious
  Injury to the bladder, urethra, bowel or other tissues in the pelvis or abdomen
  Rectal bleeding, intestinal or urinary obstruction, and impotence

Risks Associated with Implant Therapy

Very Likely
  Infection that can be treated with antibiotics
  Soreness in the implant area
  Temporary fatigue, nausea or diarrhea
  Abdominal cramps
  Bladder irritation with some bleeding
  Urinary tract infection (UTI)
Less Likely, But Serious
  Injury to the bladder, urethra, bowel or other tissues in the pelvis or abdomen
  Rectal bleeding, intestinal or urinary obstruction, and incontinence
  Movement of a radioactive seed to the lungs
  Serious infection

A recent study looked at long term (24 months) side effects in 1,291 men after surgery (radical prostatectomy) and found that 8% were incontinent and 60% were impotent (Stanford. JAMA 2000:283;354) Urinary Bladder Control at 24 months: total control (32%) occasional leakage (40%) frequent leakage (6.8%) no control (1.6%). They found that the risk of frequent leakage was higher in older men: < 60y (5.2%) 60-64y (6.6%) 65-74y (10.6%) 75-79y (27%.) The problems with impotence were also higher with age: erections firm enough for intercourse: < 60y (39%) 60-64y (21.7%) 65-74y (15.3%) 75-79y (19.1%