Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function: the patient's perspective

Urology. 1996 Mar;47(3):387-94. doi: 10.1016/S0090-4295(99)80458-0.


Objectives: To document the effects of pelvic radiotherapy on bowel, bladder, and sexual function, as reported by the patient.

Methods: A confidential questionnaire was distributed to 202 prostate cancer patients. Mean age was 70 years (range, 49 to 87) and mean follow-up was 33 months (range, 12 to 72). Radiation was given by a standard four field box technique on a linear accelerator to 60 to 66 Gy over 6.5 weeks. Treatment was limited to the prostate and seminal vesicles for small well-differentiated tumors, but otherwise included internal and external iliac nodes.

Results: Responses were obtained from 192 patients (95%). No or mild change in bowel function was reported by 64% of patients, 25% reported moderate change, and 11% reported severe change. Rectal urgency was a concern for 20%, and 5% reported fecal soiling in the preceding 6 months. Hematochezia at least once a week was reported by 9% and daily by 5%. Frequent hematochezia decreased from 17% in the second and third post-treatment years to 4% after 3 years (P = 0.02). Transfusions or laser surgery for proctitis was required by 4%. No patient required a colostomy for rectal complications. Urinary stream was unchanged or improved for 83%. Nocturia was unchanged or improved in 70%. Some form of protection for urinary incontinence was required by 2%, and 0.5% noted frequent hematuria and 2% moderate to severe dysuria. Potency prior to radiotherapy was reported by 82% and was lost following radiotherapy in 35%. Technical factors, including treatment volumes and total dose, did not correlate to the risk of moderate or severe complications.

Conclusions: The sequelae of pelvic radiotherapy as viewed from the patient's perspective reveal a major alteration in bowel function in 11%, significant bladder symptoms in 4%, and loss of potency in 35%.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Erectile Dysfunction / etiology*
  • Erectile Dysfunction / physiopathology
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Intestines / physiopathology
  • Intestines / radiation effects*
  • Male
  • Middle Aged
  • Pelvis
  • Penile Erection / radiation effects
  • Proctitis / etiology
  • Prostatic Neoplasms / physiopathology
  • Prostatic Neoplasms / radiotherapy*
  • Radiation Injuries / etiology*
  • Radiation Injuries / physiopathology
  • Radiotherapy / adverse effects*
  • Urinary Bladder / radiation effects*
  • Urination Disorders / etiology