Two minor side effects of beam therapy are pubic hair loss and fatigue. The hair loss may be temporary or permanent, but the radiation does not affect hair on the head. Fatigue, which may be marked, usually begins three to four weeks after the treatment course begins. Exercise can help; one study reported that men who walked for thirty minutes each day during the treatment period experienced less radiation fatigue.6

Symptoms of urinary dysfunction are common in men who undergo radiation treatments, both immediately following the treatment and months or even years later. Frequency, urgency, pain on urination, trouble starting the urinary stream, narrowing of the stream, and inability to empty the bladder completely are all common. Relatively less frequent are symptoms of incontinence.

Men undergoing beam therapy are assessed for urinary symptoms a number of times. At five to ten months after treatment, 12 percent of men complained of frequency, and 18 percent of urgency. Two to four years later, these symptoms of urinary irritation continued to be reported by 15 to 44 percent of men in different studies, with severe symptoms in 2 or 3 percent. One study that assessed thirty-nine men an average of thirteen years after beam therapy reported that half of them continued to report urinary symptoms, especially episodes of blood in their urine (hematuria).7 It can be argued, however, that these men were treated with technologically earlier versions of beam therapy that were less focused on the prostate and did more damage to the bladder.

For seed therapy, reports of irritative urinary symptoms are similar to, if not more severe than, for beam therapy. One study that directly compared the two forms of radiation approximately two years after treatment reported that those who had undergone seed therapy had significantly more urinary symptoms. Several studies have reported that men who are treated with a combination of seed and beam therapies have more urinary symptoms than men treated with either therapy alone; this finding is not surprising since the combination yields a higher dose of radiation than either therapy alone.8

It is important to note that although irritative urinary symptoms are common, symptoms of urinary incontinence are relatively unusual in men treated with radiation. One large study reported that only 4 percent of men were still wearing pads five years after beam therapy.9 The irritative urinary symptoms can often be ameliorated with medication.

Symptoms of impotence and erectile dysfunction are common in men who undergo either beam or seed therapy. Rates of impotence immediately following beam therapy are low but then increase progressively during the following five years to 50 to 60 percent, owing to radiation effects on the nerves and small arteries going to the penis.

The same pattern is seen after seed therapy, with a slow increase in erectile dysfunction in the first five years after treatment. Pain during orgasm (26 to 40 percent) and blood in the ejaculate (15 to 17 percent) have also been described following seed therapy. Although seed therapy reputedly causes less impotence than beam therapy, two of the three studies that directly compared the two treatments reported more impotence for men who had undergone seed therapy, while the third study reported impotence to be slightly higher following beam therapy.

It has been suggested that drugs like sildenafil (Viagra) are more

Urinary Complications

I've also had to deal with an irritable bladder. Mine wasn't happy being caught in the radiation bathing my pelvis. It now seems to register full at three ounces, and with unseemly insistence. That makes it difficult to sit through a movie or more than a hundred miles in a car. A shopping trip has to be planned with a pit stop in mind. I'm certainly becoming aware of where all the bathrooms are in town.

—Michael Dorso, Seeds of Hope likely to be effective in improving erections in men who have had seed therapy than in those who underwent beam therapy. There is also evidence, as would be expected, that men who undergo a combination of beam and seed therapy have more impotence than men undergoing either treatment alone. Two studies that compared older and newer forms of beam and seed therapies both reported lower rates of impotence with the newer forms of radiation; other complications may decrease as well.10

Bowel dysfunction is a third major complication of radiation treatment for prostate cancer. This dysfunction includes frequency (diarrhea), urgency that may lead to fecal soiling, cramping, pain in the rectum or painful hemorrhoids, and bleeding. Such symptoms can often be treated with medication and decrease over time in most patients.

In one study at five to ten months following beam therapy, one third of men had bowel frequency and urgency, 18 percent had bleeding, and 16 percent had cramping. A study five years after treatment reported that 16 percent of men were continuing to have diarrhea, and 13 percent to have rectal bleeding. A study of men thirteen years after beam therapy found that 13 percent were still experiencing some rectal bleeding.11

Although rare, another bowel complication of radiation to the prostate is rectal cancer. A 2005 study found that beam radiation,

Bowel Complications

Mornings are the worst time, because of bowel movements. Even on a low-bulk diet, I have two or three each morning, and the anus burns fiercely both during the movement and for a couple of hours afterwards. The pain is fatiguing. . . .

The oncoming of a bowel movement is itself unpleasant, and very different from a normal oncoming one. I feel a pervasive, increasing malaise, then increasing anxiety. Only later do I feel signals in the bowel, which come suddenly and urgently while my sphincter warns me I lack normal control over it.

—Charles Neider, Adam's Burden compared to surgery, increased the chances of developing rectal cancer by 70 percent.12 This figure was widely reported in the medical news media. It is crucial to put such reports in proper perspective. In the study, the chances of developing rectal cancer among men treated with beam therapy was 1 in 246 cases, compared with 1 in 386 cases among men not treated with beam therapy; thus, the risk of rectal cancer increased modestly but not enough to be an overriding factor in selecting treatment.

Studies of rectal complications following seed therapy, although less numerous, report similar findings. In one study five years following treatment, 9 percent of the men were experiencing rectal bleeding. Two studies have compared bowel dysfunction in men who had beam or seed therapy; one of them reported more dysfunction with beam therapy, the other reported the opposite.13

There is broad consensus that higher doses of radiation, whether by seeds or by beam, lead to more complications. In one study, higher doses of radiation produced urinary symptoms in 13 percent and rectal symptoms in 14 percent of men five years after treatment, whereas the comparable figures for lower doses of radiation were 4 percent and 5 percent.14 All comparisons between seed and beam therapies are tentative, since both forms of radiation treatment are still being developed.

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