Follow-up/Toxicity

Question 1

What are the most common side effects after radical prostatectomy?

Answer 1

The most common significant side effects after radical prostatectomy are ED, urinary incontinence, and urethral stricture.

Question 2

What % of men will be able to maintain erections firm enough for intercourse following definitive Tx for prostate cancer with RT or Sg?

Answer 2

Traditional teaching states that ∼50% of previously potent men will be able to maintain erections for intercourse for both modalities 1–2 yrs post-Tx. In the ProtecT trial (Hamdy FC et al., NEJM 2016) erectile function was worse at all-time points following Sg compared to RT, including during ADT.

Question 3

What % of men who undergo a radical prostatectomy have significant postop urinary incontinence? Long-term urinary incontinence?

Answer 3

40% of men who undergo a robotic-assisted radical prostatectomy have significant postop urinary incontinence at 12 wks. (Yaxley J et al., Lancet 2016) In the ProtecT trial 17% continued to require pads at 6 yrs (Hamdy FC et al., NEJM 2016) compared to 4% in the RT group.

Question 4

What are the most common acute and late side effects of EBRT and brachytherapy?

Answer 4

Acute: fatigue, urinary urgency/frequency, proctitis/diarrhea

Late: ED, cystitis, proctitis (frequency/bleeding)

Question 5

Estimate the rate of grade 3 or higher late GU or GI RT toxicity with IMRT for prostate cancer.

Answer 5

Numerous retrospective studies suggest that grade 3 or higher late GU or GI RT toxicity with IMRT for prostate cancer is rare (≤1%).