Side effects of radiation for prostate cancer

Out of the
group of 510 patients, who responded to the side effect section, 299
patients (59%) stated that there had been side effects and 211 patients
(41%) stated that none had occurred. The following side effects were
mentioned: leakage (17%), alguria (14%), diarrhoea (13%), voiding
dysfunctions with residual urine (12%), proctitis (10%),urinary
incontinence (6%), urethral stricture (5%), cystitis (3%), anal
incontinence (3%), evolution of fistulas (1%), retention (1%). 123
patients made a reply on their degree of potency. In total 123 patients
reported erectile dysfunction (ED); 24 (8% out of 299)of these had a
preoperatively existing ED prior to BT. 99 patients (33% of 299) reported
a newly occurred ED post BT treatment


AUA Abstract 1137-

This abstract was retrospective and only 1/8 of patients commented on erections, but there are obvious side effects with radiation that urologists should discuss with their patients.

Genetics and inherited prostate cancer risk

Prostate Cancer: Major Genetic Risk Factor Found: “Harvard Medical School researchers have identified a DNA segment on chromosome 8 that is a major risk factor for prostate cancer, especially in African American men. The paper appears in the August electronic edition of the Proceedings of the National Academy of Sciences (also see PNAS’s
news tip below).

‘This paper identifies a genetic risk factor that about
doubles the likelihood of prostate cancer in younger African American
men,’ says principal investigator David Reich, PhD, Harvard Medical School
assistant professor of genetics with the HMS Department of Genetics and
the Broad Institute. ‘This finding may explain why younger African
Americans have an increased risk for prostate cancer than do other
populations–and may also explain why this increased risk in African
Americans attenuates with older age.'”

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Previous Laparoscopic Hernia Repair with mesh in prostate cancer patients

This past month 2 patients of mine with prior laparoscopic hernia repairs with mesh had successful dvPs. I have done several of these now and do not get overly concerned with this finding in a patient. One of the patient’s was from Florida and was advised against robotic prostatectomy from 2 urologists that performed robotics locally due to his prior hernia surgery. This patient actually had recurrent inguinal hernias that we fixed at the same time of his robotic prostatectomy.

I think the open approach will be much more difficult in patients with prior lap hernias and would advise against open prostate surgery, but I do not feel it is a problem for myself while performing robotics. Operative reports from the original lap hernia operation are helpful. If the lining of the abdomen (peritoneum) is not covered over the mesh, this would make the dvP much harder as bowel would likely be adhered to the mesh. If the lap hernia was done extraperitoneal (this is usually the case) or the peritoneum covers the mesh, it should not be a problem.

Lymph node dissections are much more difficult with prior hernia repairs, especially lap hernias and I performed my first of these for lap hernias this past week and found it to be safe even though the mesh was placed lower than usual and partly covered the vein. I inform patients with prior surgery in this area that I may not be able to remove the lymph nodes if the reaction is too severe and I don’t feel its safe. The lymph nodes are more useful for staging and giving the patient their prognosis, but not for helping the cure rate. Fortunately I have always been able to remove the lymph nodes when I wanted to so far.

Telling someone they have prostate cancer

One of the most difficult things that a urologist has to do is to tell his patient that he has cancer. I recently had a somewhat heated debate with my partner in robotic surgery.
Prostate cancer is the leading solid organ cancer in men and is diagnosed by a biopsy in the office. The reasons for a biopsy are given by the urologist when scheduling the procedure and the urologist is present for the biopsy.
I have had discussions with my partners about the two main ways of doing this for prostate cancer and there is a difference in opinion. The two ways are over the phone or face to face.

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Smokers have increased risk of bladder cancer after radiation therapy for prostate cancer

A presentation at the AUA Western section meeting was reviewed in the Urology Times November 2005 issue:
UT article: Smokers face higher risk of TCC after radiation
Patients that have a history of smoking are 13 more likely to get bladder cancer (transitional cell cancer) after radiation as compared to patients who get radiation and have not smoked.

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