Urinary Dysfunction
Other than cancer itself the biggest concerns for prostate patients are side effects of erectile dysfunction and incontinence (lack of voluntary urinary control) both of which are not uncommon with the standard prostate cancer treatments. To the best of our knowledge there are no patients suffering from incontinence due to proton radiation from M. D. Anderson.
Incontinence is just one element of urinary function. Other elements are affected and present side effects, although not as severe are bothersome. These include slow urinary flow, burning, getting up frequently at night to urinate and dribbling. A small number of the men treated with proton therapy at the M.D. Anderson Cancer Clinic develop these symptoms. The most common is slowing of the urinary stream. It’s thought that this is caused by localized swelling around the urethra and bladder neck. Many don’t experience this at all and a lot depends on their general health and condition when they start treatment. Those symptoms are well managed by taking Flomax on a daily basis during treatment and for a few weeks afterwards.
Long term urinary complications such as incontinence are reported to be less than 1 % (1) of the men treated with proton therapy. This compares very favorably with the side effects experienced with other common forms of treatment like radical prostatectomy (RP) surgery. By researching on the Internet we find the side effects reported with RP vary quite widely where numbers as high as 32% are reported by James Metz, M.D. (2), 5% by John Ward, M.D (3), 2-6% by a Houston surgeon (4), and between 9.6-11% (5). The variability is due to multiple factors such as the age of the patient, pre-treatment condition, the skill of the surgeon who performed the RP and who is reporting the data, patient or surgeon. The patient may think any form of leakage is being incontinent where the surgeon typically thinks that 1 pad a day is ok.
The bottom line – urinary side effects from proton therapy are light, they can be managed with alpha blocker drugs, abate over time on recovery and are minor when compared to those experienced with radical prostatectomy. There are cases where RP is to be recommended but there are many cases where prostate cancer is detected early and proton therapy is the best route.
Reference 1. Robert J. Marckini, “You Can Beat Prostate Cancer”, pg. 82. http://www.lulu.com/content/483195
Reference 2. James Metz, M.D., The Abramson Cancer Center of University of Pennsylvania June 29, 2006 http://www.oncolink.org/treatment/article.cfm?c=9&s=70&id=211
Reference 3. “Advances in the Treatment of Prostate Cancer.” Patient Power, Andrew Shorr interview with Debbie Kuban, M.D. and Dr. John Ward, M.D. June 19, 2007
http://www.mdanderson.org/about_mda/patientpower/display.cfm?id=0e0725a5-46a8-46d9-8f1c9d05ee879aff&method=displayfull.
Reference 4. Information given at private patient consultation November 2006, Baylor College of Medicine, Houston, Texas.
Reference 5. PowerPoint presentation slide comparing levels of incontinence for RP and EBRT citing Potosky, Talcott and Walsh.
Please send us your input. Send your reply to Joe Landry jelandry@sbcglobal.net or if you receive this by e-mail simply click reply to Joe Landry. We are looking for comments on how you function either during treatment or well after. You can provide “your first name, e-mail address (optional) and completion date” or say “anonymous and completion date”. Also indicate if you had proton radiation only (P) or proton and hormonal therapy (PH). Always put your completion date. Please be brief.
When I was diagnosed with prostate cancer, I had an enlarged prostate and was taking an “alpha blocker” drug called Uroxatral to manage what is called irritative voiding symptoms or urgency. About half way through the treatments the symptoms increased and commuting the 20 miles to the Proton Therapy Center was problematic. I knew where every bathroom stop was located between my home and the Proton Center, just in case I needed to stop. After 11 months recovery the symptoms are almost all gone on a dose of one capsule (0.4 mg) a day of Flomax, possibly my symptoms are better than before treatment. I’m glad I chose this therapy. Keep the faith especially about recovery; it is not immediate but gradually improves with good diet, exercise, and time. Joe L. (P) jelandry@sbcglobal.net April 2007
Prior to proton radiation I had really zero urinary problems and none were created by proton radiation. I am a very enthusiastic and pleased patient.
Ban C. (P) bancapron@hotmail.com completion date February 2008
