Towards improved physical and psychological health after radiotherapy for prostate cancer - avoiding radiation - induced long-lasting gastrointestinal symptoms

Abstract

There are an increasing number of irradiated prostate-cancer survivors in the world today. For many of these men survival comes at a cost: unwanted debilitating side effects due to exposure of healthy normal tissue to ionizing radiation. Identifying clinical and dosimetric factors associated with these long-lasting side effects could provide a way of attaining the ultimate goal – curing prostate cancer with radiotherapy while restoring physical and psychological health for the prostate-cancer survivor. Following a preparatory qualitative phase, we constructed a study-specific questionnaire. In addition, we conducted a pilot study to evaluate the variation in position and volume of the organs at risk in the small pelvis. We received filled-in questionnaires from 874/985 (89%) prostate-cancer survivors and from 243/332 (73%) population-based controls. We found that prostate-cancer survivors who smoked had an increased risk of long-lasting defecation urgency, diarrhea, the sensation of bowel not completely emptied after defecation and sudden emptying of all stools into clothing without forewarning compared to never smokers. We also found that men with loose stools and abdominal distension at least once a week had a higher prevalence of several long-lasting symptoms, such as defecation urgency, fecal leakage and sudden emptying of all stools into clothing compared to those with regular stools. Prostate-cancer survivors with abdominal distension at least once a week had an increased prevalence of unexpected passing of gas compared to those with regular stools. Finally, our data showed that mean absorbed dose of ionizing radiation to the anal-sphincter region of more than 40 Gy causes an increased occurrence of fecal leakage among irradiated prostate-cancer survivors.