Complications
Caused by an irritation of the mucosal lining of the urethra.
May be treated with nonsteroidal anti-inflammatory drugs or phenazopyridine.
Caused by an irritation of the lining of the bladder and bladder neck.
May be treated with alpha-blockers.
Caused by an irritation of the lining of the bladder and urethral sphincter. Bladder spasms result in urge incontinence, which may be treated with anticholinergic medications.
After surgery, incontinence may be caused by damage to the pelvic floor muscles or damage to the urethral sphincter. Kegel exercises may be effective to strengthen the pelvic floor.
[ 
]
[Evidence B]
In a cohort study, men who underwent surgery reported clinically meaningful worse urinary incontinence (up to 5 years) compared with those who underwent other treatments (e.g., radiation therapy).[191]
Caused by an irritation of the lining of the bladder.
Caused by an irritation of the lining of the bladder and bladder neck.
Overall prevalence decreases with duration of follow-up.[407]
Caused by a temporary loss of the mucosal lining of the rectal wall.
May be treated with a low-residue diet designed to avoid gastrointestinal inflammation, and antidiarrheals.
Mild rectal bleeding is common 1-3 years after radiation therapy.[407]
The risk of severe bleeding is low. It appears similar to hemorrhoidal bleeding and is caused by neovascularization and telangiectasia formation in the rectal mucosa.
Caution should be taken when colonoscopy reveals an abnormality in the rectal wall in a patient with a history of radiation therapy. Multiple biopsies of the anterior rectal wall may result in fistula formation.
Androgen deprivation therapy (ADT) promotes weight gain, decreases insulin sensitivity, and adversely alters lipid profiles. It may be associated with a greater incidence of diabetes and stroke; increased incidence of cardiovascular disease has not been consistently demonstrated.[420][421] The increased risk of cardiovascular disease and stroke may be limited to men with drug-induced androgen deprivation and not those treated with surgical castration.[413][422][423] The benefits of ADT should be weighed against potential harms. The optimal strategy to mitigate the adverse metabolic effects of ADT is unknown.[424]
A systematic review and meta-analysis found that, based on limited evidence, exercise may benefit some markers of cardiometabolic health (e.g., diastolic blood pressure, fasting blood glucose, C-reactive protein, whole-body lean mass, appendicular lean mass, whole-body fat mass, whole-body fat percentage, trunk fat mass), but not others (e.g., systolic blood pressure, blood lipid metabolism).[425]
The American Society of Clinical Oncology has published guidance regarding exercise, diet, and weight management during cancer treatment.[396]
When dysuria or urinary obstructive symptoms occur more than 6 months after radiation therapy (more commonly after brachytherapy), they may be caused by urethral stricture.
Urinary stricture may occur more acutely after surgery.
In patients who receive radiation or undergo surgery, erectile dysfunction may be caused by damage to either the penile bulb or the neurovascular bundle.
Radiation therapy produces a vasculopathy and compromised blood supply that may be overcome with a phosphodiesterase inhibitor (e.g., sildenafil, tadalafil). The onset of erectile dysfunction following radiation is rarely before 6 months. A randomized trial showed no benefit to the administration of tadalafil during radiation in preventing erectile dysfunction.[408]
In patients who undergo surgery and suffer damage to the neurovascular bundles resulting in erectile dysfunction, phosphodiesterase inhibitors are unlikely to hasten recovery of erectile function. Evidence suggests that penile rehabilitation strategies consisting of scheduled (i.e., daily) use of phosphodiesterase inhibitors following surgery may result in similar self‐reported erections and erectile function as non-scheduled and on-demand use.[409]
In one cohort study, men who underwent surgery for unfavorable-risk disease reported worse sexual function at 5 years compared with those who received radiation therapy combined with androgen deprivation therapy.[191]
Hormone-induced erectile dysfunction is caused by a decreased level of testosterone. The effect of finasteride on sexual functioning is minimal for most men and should not impact the decision to prescribe or take finasteride.[410]
Caused by hormone alterations as a result of androgen deprivation therapy with luteinizing hormone-releasing hormone antagonists and agonists.[413]
Medroxyprogesterone effectively reduces hot flashes in men undergoing androgen suppression for prostate cancer, and may be the preferred treatment.[414] One guideline recommends paroxetine or clonidine (but not gabapentin) in preference to no treatment for men with prostate cancer who experience drug-induced hot flashes (low-quality/very low-quality evidence).[415][Evidence C]
Acute hematuria may be caused by urinary tract infection, radiation cystitis, tumor retraction, or bleeding diathesis.
Acute bleeding after a brachytherapy implant may be managed initially with bladder irrigation.
For late and/or persistent bleeding, urinary tract infection should first be ruled out. Pentoxifylline and vitamin E may be tried for 3-12 months. Hyperbaric oxygen is reserved for refractory bleeding.
Caused by an acute swelling of the prostate gland that results in obstruction.
May be treated with nonsteroidal anti-inflammatory drugs or corticosteroids.
If complete obstruction is present, then a Foley catheter should be placed. Acute urinary retention is more common after brachytherapy, and is rare during or after external beam radiation therapy.
Presents as rectal pain and/or painful bowel movements. Caused by inflammation of the muscle of the rectal wall or anus.
May be treated with corticosteroid suppositories.
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