post brachytherapy side effects

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jack54
New Member


Date Joined Dec 2014
Total Posts : 4
   Posted 12/29/2014 3:40 AM (GMT -6)   
I had the BT 23 days ago, 88 cesium seeds in my 85 cc prostate.
No problems from the procedure (other than the perineal bruise and pain that's gone now)

My problem is the "signal confusion" that started 2 days later;
Feel an urge to urinate, but when i relax the sphincter, that triggers the rectum to try to eliminate.
Which is a problem because it is empty (so obviously, not constipated)

Now, 3 weeks later, still the problem: before I can pee, the system needs to process *something* in the rectum; if there's no poop, then maybe gas, otherwise its rectal mucus.
But while that is being 'pushed' (whether or not anything comes out), it blocks the ability to urinate.

And *there's* the problem: along the perineum there's an ache (big 'ouch'),
as if the stimulation in the rectum is preventing the urinary flow.

Eventually the rectal spasm dies down (2-3 minutes of pain/spasm, less if there's actually poop),
and then I can stand and pee almost normally.
(that is to say: urinary blockage per se[\I] is not the problem; esp with the flowmax)

Does this sound familiar?
Does anyone know what's causing it? (beyond: "the radiation is messing with the nerves" ?)
Any suggestions for how to mitigate it?
[I've developed some rituals, and kegel-like moves, but still it's a pain]

GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 12/29/2014 5:48 AM (GMT -6)   
I had some bladder spasms that caused discomfort in the rectum...sure didn't seem to me like it was coming from the bladder at the time, but a mild steroid script fixed it up immediately.
Diagnosed in October, 08. One sample of needle biopsy showed Gl 6. WW for 18 months. PSA went fro 4.3 to 6.1. Surgery scared the heck out of me. Mapping biopsy of 60 samples showed. 15 were GL6, 1 was GL7. Had LDR brachy on 10/ 4, 2010
First PSA post brachy on Jan. 6: 0.24
7/ 7, '11: PSA: 0.20
1/ 5, '12: 0.25
7/ 7, '12: 0.2
1/ 7, '13: 0.1
7/5, 13: 0.1
1/3/14: <0.1
7,5/14:<0.1

browntrout
Veteran Member


Date Joined Apr 2014
Total Posts : 557
   Posted 12/29/2014 10:51 AM (GMT -6)   
Jack54: Your symptoms are very familiar. I found that walking right after a pee did wonders. Eventually didn't have to walk and symtoms are now a reminded memory.

Do you mind sharing why your Doc chose cesium? I ask because, you are the first I have encountered, as most use Iodine or Palladium.

Best wishes and please keep us posted on your progress.
Age 65, Steadily rising PSA with a jump from 3.32 to 4.3 in 5 months, April 2014
Biopsy May 9, 2014 4/12 cores 3%, 15%, 30%, .5mm, 3mm, 5mm
Gleason's 3+3=6, 3+4=7, 3+3=6, PI not id'd
Prostate Volume: 25g Ultrasound Findings: No discrete nodules
BT 7/16/14 81 pSeeds, nausea, urine blood, burning, 1/2 day, bruising, mild urinary/bowel 2 wks PSA: 8/14 1.19, 10/29 .41
Check your PSA hikes!

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 8349
   Posted 12/29/2014 11:01 AM (GMT -6)   
My brother had cesium too. Some ROs are shifting to it. Not sure why.

The symptoms should taper off after a while. Walking is good to help get things back to normal.

If it's not better in a few days a call to the doc might be in order - he might be able to give you something that could help.

Andrew
I'll be in the shop.
Age 54, 52 at DX
PSA 4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13, .7 5/14, .5 10/14
GS 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

jack54
New Member


Date Joined Dec 2014
Total Posts : 4
   Posted 12/29/2014 3:48 PM (GMT -6)   
Thanks everyone.
I've got some Anusol-HC (hydrocortisone) suppository that the docs think will quell the irritation and the spasms.
[after 3 weeks, finally a conversation with the docs! note to others: you probably don't want to do this procedure the first part of December, the docs tend to be gone a lot for the holidays]

If this happens to you, do not keep 'pushing', you need to close that sphincter, suck it up.
Wait for the spasms to subside.
Avoid any foods that cause gas, any pressure or irritant in the bowel will trigger it.

Cesium is the latest thing... better because it has higher energy but shorter half-life (8 days)
so in 3 or 4 weeks it has delivered its full therapeutic dose,
and presumably the healing can begin and the side-effects diminish.

Age: 60
10/14: PSA 4.1
11/14: biopsy; 5 of 12 positive; GS: 3+3, 3+4, Dx: T1c
12/14: Cesium brachytherapy (82cc prostate, 20 needles, 88 seeds)

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9805
   Posted 12/30/2014 2:46 AM (GMT -6)   
That feeling that there's something there in your rectum even when there isn't is called tenesmus. (I love how there's a technical word for everything in MedSpeak.) The more you push it out, the greater the risk of bleeding hemorrhoids. If the Anusol with cortisone doesn't work, there's mesalamine (available as suppository, enema, or oral pill). As you say, with Cs-131 seeds the SEs come on hard and fast but are typically gone a lot faster.

jack54
New Member


Date Joined Dec 2014
Total Posts : 4
   Posted 2/20/2015 5:25 PM (GMT -6)   
Finally time to recap the full experience of the side-effects from my brachytherapy.
[contrast with: "Tudpock's Brachytherapy" who escaped the side-effects]

Background: diagnosed with prostate cancer Nov 14
Age: 60
10/14: PSA 4.1
11/14: biopsy; 5 of 12 positive; GS: 3+3, 3+4, Dx: T1c
12/4: Cesium-137 brachytherapy (82cc prostate, 20 needles, 88 seeds)

The urologist/surgeon suggested radical surgery (w/lousy personal-skills/rapport/"bedside manner")
but I went for a second opinion and found a very competent/confident brachytherapist.
(sadly, when it came to the surgery, my doc was brought on as my urologist)

Scheduling found an opening for Dec 4
Note: this was not really enough time to meet/discuss/plan/understand with all the docs.
Especially since the docs and their admins were out for thanksgiving holiday.
[the prostate cancer page at urology.ucla.edu/body.cfm?id=447 has good info]
This schedule put my post-operative recovery in December, rather than impact work in the new year.
[well, that was the plan/expectation]
Note: I recommend *not* doing surgery the 2 or 3 weeks before christmas/new-years,
Once again, the docs and staff will not be readily available for consultation.

The surgery went smoothly, as such things go, but 20 needles in the perineum leaves its mark.

First: the immediate impact of the surgery:
* Bruising and swelling of the perineum (everything you sit on)
-- This was effectively treated with prescription pain-killer (darvocet, iirc)
-- Foam cushion, with perineal/coccyxical cutout when sitting
* The perineal nerves are stimulated/traumatized by the procedure (see below for effects)
* And lasted 5-7 days; at that point I felt pretty confident that all would be well.

Second: about this time, the radiation kicks in (88 seeds of cesium-137) weeks 1-4.
* Fatigue; basically, your metabolic reserves are consumed repairing the damage
-- Sit, lie down, take a break; you are tired: so rest and recuperate.
* Nausea; was not so bad for me, getting horizontal for fatigue also relieves the nausea
* "signal confusion" in the perineal nerves; lots of nerves run through the perineal/groin area,
the radiation causes to inflammation and irritation, so the nerves are very sensitive.
As a result, there is essentially "crosstalk": stimulation of one nerve is perceived as another nerve.
So: it feels like you need to pee, but the nerve signal crosses to the rectal nerves and causes a strong reflex to eliminate through the bowel (see also: tenesmus); In the first week, I "blew out" an external hemorrhoid;
Alternatively, pressure in the rectum can be perceived as "need to pee", the sensation of urine flowing through the ureter crosses to "erectile stimulation" (which triggers a reflex that blocks urination). Really, at this point one never knows if you are going or coming... try to pee and out comes poop. [occasionally, I would awake with a pain/cramp in my big toe: crosstalk]
What to do:
-- Relax. fight/break the reflex. hold TP (toilet paper) firmly against the anus to avoid over extending it. stand to pee (into a cup helps) hold that TP in case something drops that way.
-- suck it up: do the kegel-like exercise of closing the anus, and press finger up on perineum to get things in the right place for urination.
-- mixed success trying to urinate more often, good to not wait until there is too much pressure
-- pee into a measuring cup, so you know when you have done 3-4oz/hour (or whatever your rate is)
-- max doses of ibuprofen to reduce swelling and inflammation

Third: radiation proctitis: the radiation inflames the rectum (which further stimulates the nerve, above)
One noticeable effect is the creation/elimination of rectal mucus; which triggers the elimination response (or due to nerves above, an urge to pee, and then an elimination reflex...)
The sensitivity was extreme, the 'poop' signal could be from: gas, mucus, or any bit of fecal material in the rectum. (and the signal continues until whatever there is removed) and per above: urination is typically blocked until that rectal signal is removed. The feedback/reflex loop is treacherous...
During this phase, I was spending 20~30 minutes in the bathroom every 1-3 hours; this improved after ~8 weeks.
Note, the physical stress and pain of dealing with this further contributed to the Fatigue,
and since this was every 2 or 3 hours (even through the night) sleep deprivation was also a factor.

What to do:
-- I eventually got some Hydrocortisone suppository and that may help the inflammation (or maybe it was just time and self healing, can't be sure)
-- watch what you eat: you don't want to get constipated, but neither do you want a high-fiber diet. That was where I went wrong (because the fiber contributes to the irritation, and loose/pasty feces are more trouble to push and completely void than more formed stools. Avoid high-acid foods (an undigested tomato skin stuck to the hemorrhoid and caused extreme pain; if you get close to diarrhea, then the high-acid also leaves it mark)
-- watch *when* you eat: my cycle time is 18-20 hours, so do not eat in the morning (as that would come out in the middle of the night)
-- various postures and exercises help move things through/out the colon; standing a half-meter from the wall and leaning my coccyx/buttocks against that while stretching helped; hopping also was helpful (alternating free-fall with down-shock); vigorous bouncing/palpitating of the anal area (with that TP covered hand) helps move things down (or confirm that there's nothing there)
-- remember: it only hurts for a short time; once resolved/eliminated, the pain is gone and forgotten

After 10 weeks, life is back to almost normal, still careful of eating; still some sensitivity in the rectal nerves, but can work through the day, and sleep through the night (with a 4am trip to urinate)

Overall, I think brachytherapy was a better choice than radical surgery; but be aware that for some percentage of patients, the radiation can trigger a painful, exhausting challenge; hopefully you will have doctors that can identify and treat the problem, and by watching your diet avoid the worst of this.

Post Edited (jack54) : 2/22/2015 12:45:47 AM (GMT-7)


Casper555
Veteran Member


Date Joined Sep 2014
Total Posts : 578
   Posted 2/20/2015 6:03 PM (GMT -6)   
Thanks jack54. I just found this thread and must say my experiences of LDR are pretty much the same as yours. Lots of pain up inside my rectum and for almost four days I was not able to poop. Also a strong pain in my shaft when urinating.

My treatment was almost a month ago and now all I suffer is a mild pain during ejaculation and having to urinate sometimes twice at night. Also at night I find my flow is very restrictive and I often stand there for 5 minutes before I feel I have finished.

Thanks for your very detailed update. Like you I am very happy with the results of my LDR treatment. I had 91 Iodine seeds.
Age 64
Dec 2013 DRE Enlarged but smooth prostate.
Dec 2013 PSA 4.2 July 2014 PSA 5.1 Sept 2014 PSA 19.
Awaiting transperineal biopsy (Template Prostatic Biopsy)
Oct 21st 14 Template Prostatic Biopsy
Nov 3rd 14 Biopsy results show PC, Gleason (3+4) 7
Awaiting bone scan.
Nov 24th bone scan result negative.
Nov 25th PSA now 6.4 YES!!!!
Dec 2014. Chosen LDR Brachy treatment
Jan 27/28 LDR Brachy

BenSam
Regular Member


Date Joined Dec 2014
Total Posts : 185
   Posted 2/21/2015 9:28 AM (GMT -6)   
JACK54

Thanks for the detailed description regarding your recovery process. Though I am three weeks post treatment and I had a somewhat different procedure (HDR BRACHY MONO) I very much can relate to much of what you describe. I feel discouraged at times as I dont seem to have ongoing progress in this recovery as some of my cohorts ( and you know who you are) I need to practice the words I preach to others on this site... be patient... everyone's recovery is different...... I was up to the loo 6 times last night and that is normal still for me ... haven't slept more than 3-4 hours a night since the treatment. My DOCS tell this is normal..... ha... Im sure they are sleeping well.

The urgency, the pain, the night dribbles are awful. Things do improve in the daytime so I am hoping it continues to progress. My internal body cross-messaging is an issue for me as well. I remember one month ago, I had zero issues of any type. They fixed me and now ... well I guess I need to be positive.

BenSam


ADD-ON: It seems we have very similar PC Dx profiles and at about the same time.... I went HDR your went LDR.... We both wanted SE lite results and we both may not have been that lucky... YET

Post Edited (BenSam) : 2/21/2015 8:57:17 AM (GMT-7)


A Yooper
Veteran Member


Date Joined Jul 2012
Total Posts : 2139
   Posted 2/21/2015 9:47 AM (GMT -6)   
Thanks for the update Jack54, it sounds like things are getting better. I agree it does help that you are sharing your experience, as everyone's is different. I'm thinking that the worst of it, occurring during the "hot" phase of your Cesium-137 seeds, was the cause of what you went through - and now hopefully are past. Continued best to you.
57 yrs old, excellent health - DX'd PCa July '12
PSA 5.8
Biopsy 6/27/12
9 of 12 Gleason: 3+3 and 3+4
Negative DRE’s / NO / MO / T1C / Gland size 40gm / Vol. 22gm
Volume Study 8/14/12
Casodex 50mg daily 5 wks prior 2 wks post BT
LDR BT 9/21/12 – no issues, No SE's
3 mo PSA 12/12 0.48!
6 mo PSA 3/13 0.21!
9 mo PSA 6/13 0.30!
1 yr PSA 9/13 0.30!
18 mo PSA 3/14 0.30!
2 yr PSA 9/18/14 0.13!

PDL17
Regular Member


Date Joined Oct 2011
Total Posts : 492
   Posted 2/22/2015 1:10 PM (GMT -6)   
Jack54/Bensam

Are you both on an alpha blocker (Flomax/Rapiflo) to increase urination. When I was freshly post-op from brachytherapy, I needed to take 3 Flomax per day to eliminate getting up to pee every hour or so. It worked. After a month or so, I could cut the dose back.

Gleason 3+4; 5/16 positive cores; average volume 30%; PSA prior to tx 4.8
TX-IMRT + brachytherapy; IMRT Nov. 2011; Brachytherapy Feb. 2012
PSA April 2012--3.6
PSA May 2012--2.5
PSA Aug 2012--2.2
PSA Nov 2012--2.9
PSA Feb 2013--2.8
PSA May 2013--2.1
PSA Aug 2013--2.3
PSA Nov 2013--2.5
PSA May 2014--1.1
PSA Dec 2014--0.8


Paul

Post Edited (PDL17) : 2/22/2015 12:13:08 PM (GMT-7)


BenSam
Regular Member


Date Joined Dec 2014
Total Posts : 185
   Posted 2/22/2015 2:16 PM (GMT -6)   
PDL

thank you for this information. The urination issue is turning into a real big problem for me. Both frequency and pain. I am already taking two flomax a day and 4 uribel. I was under the impression that you could not take more than 2 flomax a day if 3 would help I will definitely ask my doctor. thanks again as this is becoming an unmanageable issue.... even worse at night...only sleeping 3-4 hours... due to urge attacks and dribble response......
AGE: 57- DX 11/20/2014

PSA
2.98 6/16/14
3.42 7/14
6.86 10/8/14
3.2 10/16/14 (done with PHI test)
4.8 1/2015

PHI-46/ T1c

BIOPSY 11/14
5/12 cancer cores,ALL GLEASON 6 (25%, 25%, 40,50, 60) One PNI in 60%

2nd Op.- (U of Chicago)-- close to first- all GL6 5/12 cores show cancer all right lobe. 50 moved up to 60%,2 -60% core readings- 1 PNI

HDRBRACHY COMPLETED Jan 28/29 2015

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2710
   Posted 2/22/2015 2:31 PM (GMT -6)   
BenSam...did your doctor ever mention urispas to you? That helped me with the burning, although it turns your pee orange and can be a bit messy if you've got some leakage.

I'm really just hoping that it takes a bit more time for you to be back to normal. As I've probably mentioned, it was a couple of weeks for me on the burning side. On the urgency issue, I had follow-up IMRT and that really didn't resolve for a month or so after that, although it was never all that bad. I do hope things clear up for you and jack54 soon!
Age 54, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
6/14: T=29, PSA = 0.02
9/14: T = 176, PSA = 0.08
12/14: T = 96, PSA = 0.16

BenSam
Regular Member


Date Joined Dec 2014
Total Posts : 185
   Posted 2/22/2015 2:38 PM (GMT -6)   
Thanks M_T... no he did not mention uripas. Uribel is supposed to do exactly that help with the burning....?? It turns the pee blue green.... like the Caribbean.... always nice for February winter in Chicago.. HA

I may ask for 3 FLOMAX a day --if that allowed if anyone knows or ask to switch to RAPIFLO?

I also wonder if laying down (as in sleeping) has some effect on lack of ability to have a stream? I find that a hot shower helps move things along but how many hot showers can one take, in really dry weather???? skin is cracking off.

I will keep trying stuff to get this resolved.....

smhair

PDL17
Regular Member


Date Joined Oct 2011
Total Posts : 492
   Posted 2/23/2015 8:07 PM (GMT -6)   
Bensam,

My brachytherapist has recommended 3 Flomax per day for many patients. He also considered switching me to Rapiflo because he thinks it is a tad better. He did not when I told him I was doing better on 3 Flomax per day.

Have you changed habits such as reducing caffeine, reducing your fluids several hours before going to bed, eliminating citrus drinks, spicy foods, etc. Supposedly these things can be irritating on your bladder and exacerbate your symptoms.

This will pass (no pun intended) but it is very frustrating while going through it. I am confident that it will get better in a short time.

Paul
Gleason 3+4; 5/16 positive cores; average volume 30%; PSA prior to tx 4.8
TX-IMRT + brachytherapy; IMRT Nov. 2011; Brachytherapy Feb. 2012
PSA April 2012--3.6
PSA May 2012--2.5
PSA Aug 2012--2.2
PSA Nov 2012--2.9
PSA Feb 2013--2.8
PSA May 2013--2.1
PSA Aug 2013--2.3
PSA Nov 2013--2.5
PSA May 2014--1.1
PSA Dec 2014--0.8

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2710
   Posted 2/23/2015 8:27 PM (GMT -6)   
My brachy doctor prescribed Flomax, but my oncologist gave me a sample for Rapiflo. Might have been just me, but Rapiflo worked much better for me.
Age 54, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
6/14: T=29, PSA = 0.02
9/14: T = 176, PSA = 0.08
12/14: T = 96, PSA = 0.16

bigrich22
Regular Member


Date Joined Oct 2014
Total Posts : 40
   Posted 2/25/2015 7:24 PM (GMT -6)   
All great information! My LDR Brachy is re-schedule for April 1st - April Fool's Day - I am actually ok with it... Like Yoop said, everyone is different. Thanks for sharing!
Age: 46
3/28/14 PSA = 5.8 DRE Neg.
8/15/14 PSA = 6.0 DRE Neg. 12% fPSA
11/21/14 PSA = 7.1 DRE Neg.
2/12/15 PSA = 6.7 DRE Neg.
10/31/14 Guided MRI Biopsy 7 of 16 cores (4 cores 3+3 and 3 cores 3+4)
11/21/14 Consultation MD Anderson
2/18/2015 LDR Brachy - Cancelled - Rescheduled 4/1/2015 NOT "April Fool's" lol

Post Edited (bigrich22) : 3/2/2015 12:06:44 PM (GMT-7)


jack54
New Member


Date Joined Dec 2014
Total Posts : 4
   Posted 3/2/2015 1:53 AM (GMT -6)   
For the record, yes; i've been taking Tamsulosin HCl 0.4mg (aka FlowMax), 1 a day.
[before comparing the x-per-day, check the dosage; it's a beta-blocker and can induce low BP]

The good news is that urinary function has not been much of an issue for me.
That is: once it flows, it flows; just need patience to get it all out.
Patience-1: wait for everything to relax, releasing 2-4 oz
Patience-2: wait again to get more out

The main problem for me was that *anything* (gas, mucus, feces) in the rectum would be perceived as "need to pee". Especially with the radiative proctitus, there was a constant supply of mucus, and that drove the system at the 1-2 hr rate, then eventually slowed to 2-4 hrs.

Now, 3 months after procedure, the nervous system irritation and signal confusion is mostly gone back to normal. Now getting the digestive system back to regular; so still watching what and when to eat.

A Yooper
Veteran Member


Date Joined Jul 2012
Total Posts : 2139
   Posted 3/2/2015 7:15 AM (GMT -6)   
jack54, good to hear that things are improving! I was DX'd with IBS several years ago, and based on that I for sure watch what I eat, how much I eat, and when I eat. Ticked me off at first, but once I got into a "pattern" I find it to be a non-issue. Of course the side benny is it helps with my overall workout routine and maintaining the weight range I want!

Hang in there and continued best, sounds like you're on the right track.
57 yrs old, excellent health - DX'd PCa July '12
PSA 5.8
Biopsy 6/27/12
9 of 12 Gleason: 3+3 and 3+4
Negative DRE’s / NO / MO / T1C / Gland size 40gm / Vol. 22gm
Volume Study 8/14/12
Casodex 50mg daily 5 wks prior 2 wks post BT
LDR BT 9/21/12 – no issues, No SE's
3 mo PSA 12/12 0.48!
6 mo PSA 3/13 0.21!
9 mo PSA 6/13 0.30!
1 yr PSA 9/13 0.30!
18 mo PSA 3/14 0.30!
2 yr PSA 9/18/14 0.13!
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