Urinary Side Effects
Urinary side effects are temporary but common for patients undergoing prostate cancer treatment. Brachytherapy side effects may include feelings of urgency, frequent urination, and slower and weaker urinary streams. These urinary side effects occur immediately following the seed implants as well as in the months following, but subside as the radioactive material begins to decay.
Immediately after the seed implants, a patient may feel an immediate sense of urgency. Having been treated with multiple needles, the prostate gland is swollen and irritated. Because of proximity of the prostate gland to the bladder and the urethra, feelings of urgency tend to ensue. The insertion of the catheter or cytoscope during the treatment may also contribute to the feelings of urgency. The irritation a patient feels after having treatment tends to subside within two weeks.
The feelings of urgency will return shortly after they go away. The radiation of the brachytherapy seeds causes these new side effects. The feeling of urgency will be the strongest when the radiation from the seeds is the strongest, approximately 2-6 weeks after having the implant. Those whom have undergone brachytherapy seed implants may need to schedule their activities around urination to avoid the discomfort of being caught without a restroom available.
Most patients say that they regain normal pre-operative urinary function within a few months of the brachytherapy implants. In the interim, many doctors recommend that patients avoid foods that tend to irritate the bladder and cause further discomfort:
- Alcoholic beverages
- Apple juice
- Carbonated beverages
- Spicy foods
- Citrus fruits or drinks
- Coffee (including decaffeinated coffee)
- Cranberries and cranberry juice
- Vitamin B complex
- Vitamin C
Sex after Brachytherapy
Sexual side effects are also common. There is some controversy about what causes erectile dysfunction after brachytherapy seed implants. Some researchers speculate that the long-term effect of radiation in the body can damage the nerves that stimulate erection or the blood vessels that supply blood to the penis.
Some patients who undergo brachytherapy seed implants also report a shortening of the penis. Some researchers speculate that shortening the urethra causes the penis to shorten as well. Other researchers, however, note that in external beam radiation therapy, some patients have reported penile shrinkage as well, indicating that the radiation may cause the shortening.
The prostate gland and the seminal vesicles are responsible for creating the fluid that makes up semen. Consequently, most men report a decrease in their amount of ejaculation. Men are still able to experience orgasm though their ejaculation will be reduced. About 5% of patients who have undergone brachytherapy report completely dry orgasms, while about 5% of brachytherapy patients report no change in their ejaculation. Some patients report pain with their first ejaculation after the brachytherapy seed implants. The pain, however, subsides with subsequent ejaculations.
Generally, most doctors believe that the testicles will continue to produce sperm after the brachytherapy seed implants. Some patients have been able to conceive healthy children after receiving brachytherapy. Most doctors, however, advise not trying to conceive until at least 18 months after brachytherapy, though it is unlikely that potential children would be affected. Younger men who undergo brachytherapy and still want to have children, may want to consider banking sperm before undergoing treatment.
Brachytherapy seeds usually stay in place, though minimal seed migration may occur. Seed migration occurs when a brachytherapy seed does not stay in place in the prostate gland and moves to another part of the body. Usually, brachytherapy seeds will migrate to the urethra or bladder, though sometimes a seed may migrate to the lungs. There is no evidence that suggests that the lungs may be affected by a loose brachytherapy seed.
If patients find that they pass a seed during urination, they should use a pair of tweezers to pick up the seed and wrap it tin foil. They should then return the seed to their doctor. If a seed is accidentally flushed down the toilet, the patient should not worry. A seed will not affect a municipal water supply. Patients may also pass seeds during ejaculation. Doctors encourage their patients to use condoms the first few times during intercourse. Ejaculation may also appear red or even brown the first few times, but this discoloration is normal and not cause for alarm. Doctors also encourage their patients to masturbate the first few times after brachytherapy, if patients do not wish to use condoms.