Richard Whittington, MD
Last Modified: March 3, 2002
Dear OncoLink "Ask The Experts,"
My husband, age 64,was diagnosed with prostate cancer in mid November. He decided to have the seed implant. Both his radiation oncologist and urologist said the procedure went extremely well but his side effects still persist with great discomfort.
He has had urinary retention and he is still quite uncomfortable. He is already taking Flomax 0.4mg twice daily as he has the urge to go to the bathroom about every hour. He gets up so often during the night, that he has not had a good night sleep since he did the procedure and is always tired. Often he is unable to differentiate between the urge to urinate or defecate and his renal area is still very sensitive and irritated. The procedure seemed to make his former mild "hemorrhoid problem" worsen as he hardly knew he had a problem before. As directed, he is using " Anusol" to calm the area and was told to take warm baths as the moist heat would help.
What specific suggestions do you have to relieve his discomfort from the side effects?
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
What you describe are typical symptoms following prostate brachytherapy (seed implants). Urinary retention lasting up to a week occurs in 10% of the patients and everybody gets frequency, urgency, night-time hesitancy and decreased force of stream. Because of pelvic congestion caused by the implant, hemorrhoids can be a real problem. We tell people to expect these side effects and it will start to get better 3 to 4 weeks after the implant but won't be normal until about 10 to 12 weeks after the implant. For hemorrhoids we typically recommend moist heat and witch hazel pads (TUCKS or a generic brand are identical) to cover the entire hemorrhoid and let it sit for 15 minutes 2 to 3 times a day. Also many men have a sensation that after voiding there is more urine in the bladder that will not come out. Do not try to push it out. The sensation is due to the implant and pushing will cause the hemorrhoids to worsen. The urge to defecate is a similar problem. The prostate is swollen and it is pushing on the outside of the rectum and men get an urge to defecate with no stool in the rectum. Again, straining makes hemorrhoids worse. Many men find they do better if they sit to urinate during the first 4 to 6 weeks. The symptoms would have been just as bad with external beam radiation. Just remember that these are temporary. If they persist for 8 to 10 weeks, a cystoscopy may be helpful to rule out a partially extruded seed if it was not done after the implant. Similarly, the urologist should rule out a prostatitis.