Side effects of brachytherapy: Anyone have urinary and bowel issues?

Other than more frequent & urgent urination, I had no urination issues and no bowel issues.

I used Depends pads in case of urine dribbles. Good for peace of mind. Stopped after a month or so.

To help prevent urination difficulty, I started taking Tamsulosin (Flomax) about a week before my HDR Brachytherapy (March2024). In retrospect, I probably did not need it. The only side effect I noticed was lightheadedness. IIRC, I stopped taking Flomax after about a month.

A rectal spacer (SpaceOar) was placed on the same day I had HDR Brachytherapy. This was done to protect my bowel from radiation -- especially during subsequent SBRT treatments. The spacer made my poop smaller diameter, so I took a stool softener (Metamucil) after every meal to help prevent constipation.

To OP did you have LDR (seeds) Brachytherapy or HDR Brachytherapy? Did you have a rectal spacer? Did doctors offer you any Flomax, etc for the urinary issues? Great post by retiredboomer71 if you had HDR procedure.

@retiredboomer71 Hi, Great to hear all went well with your HDR Brachytherapy. Do you mind me asking a few questions as I'm having the same HDR Brachy procedure done with SBRT after. Did you do any ADT? What were your stats prior to the treatment? Did you have treatment done at a cancer center of excellence? Thanks and best wishes.

@copyman
Prior to radiation therapy, at age 71 I was diagnosed Gleason 9 (4+5) with PSA 31. Fortunately only Stage 2 and confined to the prostate.

My one year of ADT (Orgovyx) started Jan2024 about 6 weeks before HDR Brachytherapy + 5 sessions SBRT with Dr Chang at UCLA, a center of excellence.

So far, VERY successful outcomes:
-- PSA consistently in the 0.2's over the past year
-- testosterone recovered quickly and actually increased to 521 from pre-treatment 454
-- I'm guessing my prostate is smaller because urination frequency is a bit less
-- my adult acne is almost completely gone, which I believe is a result of reduced inflammation
-- I feel great! And very grateful.

Most importantly, so far there's no evidence of disease. So hopefully no recurrence anytime soon.

Negatives? Trigger finger & some stiffness developed in both hands that eases with use, neuropathy on the bottom of both feet, ED that responds to Tadalafil.

Best wishes.

I didn't have much in the way of side effects from my high dose rate brachytherapy. I was reluctant to touch my perineum as I felt it would be painful due to all the needles they put in there during the procedure but I don't recall any actual pain. (see the attached graphic of HDR needle placement). My pretreatment research explained it was fairly typical to be bothered by urinary side effects for a long enough period afterwards I'd think things would never return to normal, before they resolved. My experience was almost nothing happened. No burning on urination.

The HDR was followed by 20 sessions of external beam.

I crashed after the external beam treatments. For several weeks I experienced fatigue such as I had never experienced before. Resting did nothing to make me feel better. All food tasted bad. I lost 5 pounds very quickly until I forced myself to eat even when I'd feel like I would just throw it all up soon after. Although I had a serious commitment to make it to the gym no matter what, there were days I could not make it. The recovery was extremely gradual, but at least after the first two weeks or so there was a tiny but noticeable improvement every day or few days.

I think the crash was not just the external beam, or a combination of the HDR + external beam. I think it was a culmination of the RT treatments plus the stress of being diagnosed, finding myself facing a serious disease, and trying to make up my mind about where to be treated and how to be treated.

At one point, after I had committed to a prostatectomy, I read the surgeon's clinical note and found in bold type that he had strongly recommended against surgery. The surgeon had not mentioned this to me during the appointment where he had scheduled the surgery. I found it very stressful to realize I had to be wary of things like this, as I cancelled out on ever seeing this guy again.

I had also just committed to a move, i.e. selling our house and buying another one. I was packing up and trying to settle into a new place at the same time. To be treated I had to figure out how to live in the big city 3 hours from my home for about a month.

Eventually, after somewhat more than a month, all the side effects are gone. My LUTS has improved from what they were prior to the radiation treatments, probably due to a shrinkage of my prostate. I have no "bowel bother" at all.

My HDR was conducted by an expert brachy therapist at an NCI designated institution, Fred Hutch in Seattle. My pretreatment research indicated it was important to get brachy from a very experienced doctor - more important than who did the external beam. The external beam was at the same place.

A more general discussion of side effects of high dose rate brachytherapy are near the bottom of this webpage from Memorial Sloan Kettering
https://www.mskcc.org/cancer-care/patient-education/high-dose-rate-brachytherapy-treatment-prostate
Low dose rate brachytherapy side effects are discussed in this webpage from Western Radiation Oncology. WRO are a high volume center specializing in low dose rate brachy.
https://westernradiationoncology.com/wp-content/uploads/2022/08/Brachy-FAQ-Side-Effects.pdf

There are comments from a number of people in this forum about brachytherapy

There are several discussions related to brachytherapy for prostate cancer, including these:
- Brachytherapy? Anyone have thoughts?
https://connect.mayoclinic.org/discussion/brachytherapy-anyone-have-thots/
-
Immediate Side effects of Brachytherapy
https://connect.mayoclinic.org/discussion/immediate-side-effects-of-brachytherapy/
-
Brachytherapy: Regrets & Why ?
https://connect.mayoclinic.org/discussion/brachytherapy-regrets-why/
-
ADT with EBRT and Brachytherapy
https://connect.mayoclinic.org/discussion/adt-with-ebrt-and-brachytherapy/
See all: https://connect.mayoclinic.org/group/prostate-cancer/
https://connect.mayoclinic.org/discussion/brachytherapy-2/

@hadleym, welcome. I hope you've seen the helpful comments from fellow members to your question about brachytherapy side effects. How long ago did you finish brachytherapy? Are things improving?

I had LDR brachytherapy over 2 years ago and my PSA has gone up to 2.68 have had 2 PSMA pet scans and they were negative for reoccurrence am scheduled for another pet scan sometime in October did not have Space Oar before my brachytherapy.I have trouble emptying my bladder and have ED and nothing i take helps.

@climateguy So the surgeon who was going to operate on you advised AGAINST surgery in his notes - but never TOLD you about this?!!
I mean, seriously, W…T…F…??
Phil

in reply to @heavyphil
It was extremely weird to experience this. This was a urologist at an NCI designated cancer center. I had been seeing a community urologist in a small town an hour away but I wanted to transfer my care to this center of excellence.

I had no idea what the best treatment was that I should accept. He described surgery or radiation as producing equal outcomes. He at no time said anything like he was advising against surgery. He advised that I also see an RO, I agreed, and he scheduled an appointment for me. I scheduled an appointment for surgery with him. The understanding was there would be no problem cancelling, but if, after see the RO, I made a decision to get surgery, I would be a bit further ahead in the line. The furthest I went to indicate a preference for surgery was to say, at this point I am leaning toward surgery. When I told him this, we both knew I had yet to see an RO.

A few days later I read his clinical note. In bold type, it said: "Despite my recommendation for radiation treatment given his age and high risk disease and possible increased risk of stress urinary incontinence the patient would really like to proceed with surgery".

I immediately wrote him to say please refer me to any other urologist at this place as I need a doctor who will level with me.

This was a very disturbing experience for me. I had delayed for months before I took my rising PSA seriously enough to start getting it investigated. It had taken months from when I made this appointment to this moment when I was telling this guy I never wanted to see him again. I assumed this cancelling out on this guy, meant more months of delay. The only thing that made sense to me was this guy was using this clinical note to cover his butt in case the outcome of his surgery, if he eventually did surgery on me, turned out terribly. He could point to this clinical note and say he warned me. I thought it was possible that no one else at this place would agree to see me now that I had cancelled out like this. My wife told me she had never seen me this shaken up over anything.