Monday, January 23, 2023

Blood In Urine Years After Radiation For Prostate Cancer

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Incontinence Pads And Sheets

What Does Blood in the Urine Mean? | Ask Prostate Expert, Mark Scholz, MD

You might need to wear pads when you first start going out. There are different types of pads. You might be able to get some pads for free on the NHS, although this may depend on the service in your area. Some GP practices have a continence nurse you can see.

It can also help to visit places where you know there are toilets. Or you can telephone beforehand to find out about toilets and how easy they are to get to.

Hematuria May Occur Years After Brachytherapy

Gross hematuria can occur in men up to several years after undergoing prostate brachytherapy, according to a study.

The condition is more likely to develop in men with larger prostates volumes , those who also undergo external beam radiotherapy , and those who are free from biochemical failure, researchers reported online ahead of print in BJU International.

Michael S. Leapman, MD, and collaborators at the Mount Sinai School of Medicine in New York reviewed hematuria outcomes in 2,454 patients who had transperineal prostate brachytherapy over a 20-year period. The study population had a median follow-up of 5.9 years.

Of the 2,454 patients, 218 reported gross hematuria at a median time of 772.2 days after seed implantation.

Only 3.8% of men with PSA failure reported hematuria compared with 9.4% of those with biochemical control, the researchers noted. A possible explanation for this finding is that differences among patients may affect their response to radiation, with respect to both toxicity and disease control. Patients who are more sensitive to radiation may be more likely to have a favorable treatment response, but also experience increased mucosal injury or necrosis that leads to hematuria, Dr. Leapmans group explained.

The authors pointed out that the significance of observed blood in urine after permanent brachytherapy remains unclear and warrants further study to understand the etiology and clinical course of this morbidity.

Urinary Problems After Prostate Cancer Treatment

Many men get urinary problems as a side effect of their treatment. This is because prostate cancer treatment can damage the nerves and muscles that control when you urinate .

If youre starting treatment for prostate cancer, ask your doctor about the possible side effects. Each treatment can cause different urinary problems. Your chances of getting each side effect will depend on the treatment youre having, and on whether or not you had urinary problems before starting treatment.

If youve already had prostate cancer treatment and you have urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes to help manage them.

Depending on the type of problems youre having, ways to manage them can include lifestyle changes, pelvic floor muscle exercises, bladder retraining, medicines or surgery. For practical tips read our How to manage urinary problems guide.

Watch Paul’s story below for one man’s experience of managing urinary problems after prostate cancer treatment.

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What Can Help With Urinary Frequency And Urgency

There are treatments that can help with urinary frequency and urgency, as well as things you can do yourself.

Bladder retraining

If you need to urinate more often than usual or sometimes leak before reaching the toilet, you could try a technique called bladder retraining. This can help you control when you urinate, and help you hold on for longer. Speak to your specialist continence nurse or physiotherapist for more information.

Medicines

Drugs called anti-cholinergics can help to reduce frequency, urgency and leaks. If you can’t have anto-cholinergics, you may be offered mirabegron tablets.

Percutaneous posterior tibial nerve stimulation

This treatment may help some men to urinate and leak urine less often. A needle is placed under the skin just above your ankle. A low electrical current is passed through the needle to affect the nerves that control urination. This can help stop the bladder from emptying before its full.

Youll normally have PTNS once a week for 12 weeks. Each treatment lasts about half an hour. PTNS has no serious side effects, although the area where the needle enters the skin may feel a little sore afterwards.

Sacral nerve stimulation

This is sometimes called Sacral Neuromodulation . A small wire is surgically placed against the sacral nerve in your lower back. The other end of the wire is connected to a small box . The SNS device makes mild electrical pulses that stimulate the sacral nerve to help you regain control of your bladder.

Botulinum toxin

How Long Does It Take For Radiation Side Effects To Go Away

Lethal outcome after pelvic salvage radiotherapy in a patient with ...

The general effects of radiation therapy like fatigue, nausea, and headaches resolve fairly quickly after treatment. Your body just needs time to process the radiation but can recover within a few weeks.

Delayed side effects of radiation therapy, on the other hand, may require further treatment to alleviate. Its important to use an ongoing therapy like hyperbaric oxygen therapy to enhance the bodys healing response and optimize the bodys response to radiation damage. Without additional care, some radiation side effects like burns and inflammation can morph into chronic, non-healing wounds that trigger additional health complications.

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Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Blood In Urine After Prostate Cancer Treatment: What You Need To Know

There are a number of reasons men with prostate cancer develop bleeding in urine. Hematuria can occur in patients with newly diagnosed prostate cancer as a result of cancer overgrowth that causes symptoms such as a urinary infection or difficulty voiding. More commonly, blood in the urine can occur during radiation treatment for prostate cancer.

Bleeding from Prostate

A small amount of bloody urine can be expected after a prostate biopsy that is performed to diagnose prostate cancer. In addition, blood in urine is expected after surgery for prostate cancer. Typically the amount of blood should be small and should resolve within a week after surgery. However, you might see a small amount of blood in urine on and off for a few weeks after surgery.

Blood in the urine can also be expected after radiation brachytherapy for prostate cancer. One may also experience blood in urine after external beam radiation to the prostate, such as IMRT.

After radiation therapy, blood in urine typically starts within a few weeks after treatment initiation it is usually minor and intermittent and resolves within the first few months after radiation therapy. In patients at risk, such as smokers and the elderly, a full evaluation should be performed. Persistent bloody urine after radiation therapy should be fully evaluated due to increased risk of bladder cancer in men with prostate cancer as well as increased risk of secondary bladder cancer after radiation therapy.

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Possible Side Effects Of Radiation Treatment For Prostate Cancer

The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.

You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.

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Swollen Legs Or Scrotum

Urinary Incontinence after Radical Prostatectomy | Prostate Cancer Staging Guide

You might get swelling in the legs or the sack of skin around the testicles . The swelling is called lymphoedema . It happens when the lymph channels that drain fluid from the legs are damaged by the radiotherapy. The swelling can be uncomfortable.

You can do various things to lower your risk of getting lymphoedema. Early treatment can reduce the swelling and stop it from getting worse.

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Stereotactic Body Radiation Therapy

This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.

SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife®, X-Knife®, CyberKnife®, and Clinac®.

The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.

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Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

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Myth : You Have To Start Treatment Right Away

Fact: You and your doctor may decide not to treat your prostate cancer. Reasons include:

  • Itâs in an early stage and is growing very slowly.
  • Youâre elderly or have other illnesses. Prostate cancer treatment may not prolong your life and may make it harder to care for your other health problems.

In such cases, your doctor will likely suggest âactive surveillance.â This means that theyâll check you often and order tests to see if your cancer is getting worse. If your situation changes, you may decide to start treatment.

Myth : A High Psa Score Means You Have Prostate Cancer

Long

Fact: Not necessarily. An inflamed prostate can drive up your numbers. The score helps your doctor decide if you need more tests to check for prostate cancer. Also, theyâll watch your PSA score over time. If itâs on the rise, that could be a sign of a problem. If it goes down after cancer treatment, thatâs great.

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Radiation Cystitis Causing Hematuria

Less common but challenging to treat is what we call radiation cystitis. This occurs in 1-2% of men after radiation treatment to the pelvis all the prostate. The bladder and the prostate become friable and bleed easily. Hematuria as a result of radiation cystitis typically occurs many years after treatment. A number of treatment options available, including fulguration, intravesical instillations, medical treatment. Hyperbaric oxygen treatment has been shown to be beneficial for men with persistent intermittent hematuria.

If you experience blood in urine before, after, or during treatment for prostate cancer, urological evaluation should be sought.

Side Effects From Radiation

Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. âItâs more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,â Calvaresi said. These problems often go away once treatment is complete.

Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

Men undergoing radiation are likely to have ED, but not immediately. âIt slowly sets in after radiation treatment,â Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

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Urinary Control After Surgery

Most often scarring after radiation involves the urinary sphincter muscle at the bottom of the prostate . The sphincter muscle allows men to keep urine in their bladder and prevents leakage. Fortunately, men have two sphincter muscles and there is one at the opening of the bladder where the bladder meets the prostate . Even if the lower sphincter is destroyed because of the radiation damage, the upper sphincter can keep men from leaking urine.

In some circumstances, however, the upper sphincter does not work or needs to be removed because the scarring is extensive. If this happens then patients need to have an artificial urinary sphincter placed after they have healed from the urethral surgery.

Artificial Urinary Sphincter

An artificial urinary sphincter is a silicone donut, which is placed around the urethra . This sphincter or cuff is connected internally to a pump within the scrotum and a reservoir in the abdomen. The pump sits next to the testicle and when someone wants to urinate they squeeze the pump and the cuff deflates and allows urine to flow. Over the next two minutes or so the cuff self inflates and puts pressure back on the urethra.

Wait Time for Artificial Sphincter Placement

Unfortunately patients need to wait long enough to make sure that the urethra has completely healed. This is about three months after the catheters are all removed from the urethral surgery. Then another surgery is done to place the artificial sphincter around the urethra.

Scheduling Appointments For Blood In Urine Treatment At New York Urology Specialists

Fixing Urinary Leakage After Prostate Cancer Surgery | Ask A Prostate Expert, Mark Scholz, MD

We have excellent reviews from patients and their partners. Information for out-of-state and international patients. Find out our office hours or directions to our office.

We offer affordable appointment prices with or without insurance. Same-day virtual video appointments and in-person appointments are available.

Dr. Shteynshlyuger MD is a board-certified urologist in NYC who specializes in treating urinary problems in men and women. He has performed hundreds of bladder, kidney, vaginal, and prostate surgeries.

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Late Effects After Radiation For Prostate Cancer

Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged, causing side effects. As radiation techniques have improved over the years, the risk of late effects has decreased.

Bladder Problems

Radiation to the bladder area can cause late effects to the bladder including:

Bowel Problems

The bowel is sensitive to the effects of radiation. The late effects that may occur after radiation treatment that includes the rectum, colon, or small bowel include:

Lymphedema Risk

Surgery to remove lymph nodes or radiation to lymph nodes can cause damage to lymph nodes and lead to lymphedema. Lymphedema is swelling that can happen in the genital area, belly, buttocks, legs or feet after treatment. It can cause pain, be disfiguring, make activity difficult, and increase the risk of infection in the area.

  • Talk to your provider if you are having any new swelling. A Certified Lymphedema Therapist should be consulted at the first sign of swelling to try to keep the lymphedema from worsening.
  • You are at risk of infection in any area with lymphedema or that is at risk for lymphedema. If you experience any signs of infection, contact your care team right away or go to the emergency room. These signs include a sudden increase in swelling, an increase in pain, redness, the area is warm to the touch, or fever.

Impact on Reproductive Organs, Sexual Function, and Fertility

Nerve Damage

Skin Changes

Ways To Manage Bladder Changes

  • Strengthening the pelvic floor muscles can help with bladder control. Ask your doctor for a referral to a continence nurse or physiotherapist, or contact the National Continence Helpline on 1800 33 00 66.
  • Let your treatment team know if you have bladder or urinary problems, as they will be able to suggest strategies and may recommend medicines. To help manage these side effects, drink plenty of fluids, limit strong coffee and tea, and avoid drinking alcohol.

The blood vessels in the bladder and bowel can become more fragile after radiation therapy. This may mean you see blood in your urine or bowel motions, even months or years after treatment. Always let your doctor know if you notice new or unusual bleeding.

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