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Prostate Cancer (Expert Forum)
prostate cancer
Answered by
Ash Tewari, MD, M.Ch. - Prostate Cancer, Robotic Prostatectomy, Urology, Oncology, Surgery
Weill Medical College of Cornell University
New York - NY
This forum is for questions about: Advanced or Metastatic Prostate Cancer, Biopsy, Bone Scan, Blood in Urine or Semen, Benign Prostatic Hyperplasia (BPH), CT Scan, Cystoscopy, Erectile Dysfunction, Hormone Therapy, Incontinence, Pain (abdomen, low back or hip), PSA Test, Prostatitis, Radiation Therapy, Rectal Exam, Recurrent Cancer, Risk Factors, Screening, Staging (Tumor size; Metastasis), Surgery, Transrectal Ultrasound, Urinary Difficulty or Burning, Urinary Urgency (Leaking), Watchful Waiting.
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Doctor's Answer
by Ash Tewari, MD, M.Ch., Nov 30, 2008 05:52PM
, Nov 30, 2008 05:52PM
Thanks for your post. Approximately one third of patients experience acute symptoms of proctitis or cystitis during the course of radiotherapy for prostate cancer. Symptoms subside for the vast majority of patients after the completion of therapy. About 5% to 10% have permanent symptoms such as irritable bowel syndrome and intermittent rectal bleeding or bladder irritability and infrequent blood in their urine.
Medical therapy, such as sucralfate enemas, oral metronidazole or sterorid enemas have shown to be relatively safe treatment options. Endoscopic treatments include thermal methods such as argon plasma coagulation (APC) and simple heater probe coagulation.
According to a recent review of the medical literature, APC is probably the most frequently used endoscopic therapy to treat bleeding in post radiation proctitis. The advantages of APC over other techniques are that it is a non-contact method, easy to use and has limited depth of tissue penetration. Although there is currently mixed evidence and no controlled trial evidence, success rates are between 83 and 100%, with the usual number of treatments being between one and four. Complications are unusual, but include rectal stenosis, rectovaginal fistula, tenesmus and rectal pain.
I cannot give you an exact percentage of patients with proctitis treated with argon plasma coagulaton following treatment for prostate cancer, but I can tell you that there is evidence that it is an effective treatment option. I would suggest discussing this and other treatment options with your urologist and gastroenterologist.
I hope this helps.
Best,
AT
Reference: K.
Leiper, A. I. Morris Treatment of Radiation ProctitisClinical Oncology (2007) 19: 724e729
Campbell's Urology, vols 1-4 edited by Patrick C. Walsh, Alan B. Retik, E. Darracott Vaughan,Jr, et al, 9th ed,
Medical therapy, such as sucralfate enemas, oral metronidazole or sterorid enemas have shown to be relatively safe treatment options. Endoscopic treatments include thermal methods such as argon plasma coagulation (APC) and simple heater probe coagulation.
According to a recent review of the medical literature, APC is probably the most frequently used endoscopic therapy to treat bleeding in post radiation proctitis. The advantages of APC over other techniques are that it is a non-contact method, easy to use and has limited depth of tissue penetration. Although there is currently mixed evidence and no controlled trial evidence, success rates are between 83 and 100%, with the usual number of treatments being between one and four. Complications are unusual, but include rectal stenosis, rectovaginal fistula, tenesmus and rectal pain.
I cannot give you an exact percentage of patients with proctitis treated with argon plasma coagulaton following treatment for prostate cancer, but I can tell you that there is evidence that it is an effective treatment option. I would suggest discussing this and other treatment options with your urologist and gastroenterologist.
I hope this helps.
Best,
AT
Reference: K.
Leiper, A. I. Morris Treatment of Radiation ProctitisClinical Oncology (2007) 19: 724e729
Campbell's Urology, vols 1-4 edited by Patrick C. Walsh, Alan B. Retik, E. Darracott Vaughan,Jr, et al, 9th ed,
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