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Treatment Option Overview for Prostate Cancer

    Table 9. Treatment Options by Stage for Prostate Cancer continued...

    Definitive EBRT can result in acute cystitis, proctitis, and enteritis.[17,34,41,59,60,61] These conditions are generally reversible but may be chronic and rarely require surgical intervention.[61]

    A cross-sectional survey of prostate cancer patients who had been treated in a managed care setting by radical prostatectomy, radiation therapy, or watchful waiting and active surveillance showed substantial sexual and urinary dysfunction in the radiation therapy group.[38] (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information.)

    Radiation is also known to be carcinogenic.[62,63] EBRT for prostate cancer is associated with an increased risk of both bladder and rectal cancer. Brachytherapy is associated with an increased risk of bladder cancer.

    Reducing complications

    Potency, in most cases, is preserved with radiation therapy in the short term but appears to diminish over time.[61] Sildenafil citrate may be effective in the management of sexual dysfunction after radiation therapy in some men.

    Evidence (sildenafil):

    1. In a randomized, placebo-controlled, crossover design study (RTOG-0215) of 60 men who had undergone radiation therapy for clinically localized prostate cancer, and who reported erectile dysfunction that began after their radiation therapy, 55% reported successful intercourse after sildenafil versus 18% after placebo (P < .001).[64][Level of evidence: 1iC]

    Morbidity may be reduced with the employment of sophisticated radiation therapy techniques—such as the use of linear accelerators—and careful simulation and treatment planning.[65,66]

    Evidence (3-dimensional conformal vs. conventional radiation therapy):

    1. The side effects of similar doses of 3-D conformal radiation therapy and conventional radiation therapy (total dose = 60–64 Gy) have been compared in a randomized, nonblinded study.[66][Level of evidence: 1iiC]
      • No differences were observed in acute morbidity, and late side effects serious enough to require hospitalization were infrequent with both techniques; however, the cumulative incidence of mild or greater proctitis was lower in the conformal radiation arm than in the standard therapy arm (37% vs. 56%; P = .004). Urinary symptoms were similar in the two treatment groups, as were local tumor control and OS rates at 5 years of follow-up.

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