Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation

Main Article Content

Saif Ur Rehman
Shafaq Maqsood
Aneela Deevan


Background: Pelvic radiotherapy is a primary treatment modality for organ-confined prostate cancer and early-stage endometrial cancer. While effective in improving survival rates and reducing recurrence, it is associated with a range of side effects that can impact patient quality of life.

Objective: The study aimed to assess the incidence, management, and resolution of acute and chronic side effects of pelvic radiotherapy in prostate and endometrial cancer patients, focusing on bowel and bladder functions.

Methods: This single-center, observational study included 50 patients diagnosed with prostate or endometrial cancer who underwent pelvic radiotherapy with a dose of 66-70 Gy using a four-field technique on a linear accelerator. Patients were assessed for bladder and bowel dysfunction, with follow-up at 6, 12, and 18 months post-treatment. Statistical analysis involved univariate weighted distribution of response frequencies and paired t-tests for ordinal scale scores, using SPSS version 25 for data analysis.

Results: Of the participants, 22% experienced dysuria, 64% reported bladder outlet obstruction, and 20% had constipation. Acute bowel symptoms like diarrhea occurred in 32%, and chronic proctitis developed in 22% of patients. Urinary symptoms appeared by the third week and generally resolved within weeks; however, bowel symptoms persisted longer but returned to baseline by 18 months post-treatment. Approximately 70% of patients reported good tolerance to radiotherapy.

Conclusion: Pelvic radiotherapy is effective in treating prostate and endometrial cancers but requires management of transient side effects to improve patient outcomes. Advanced radiotherapy techniques such as IMRT and 3D CRT have shown potential in reducing these side effects, emphasizing the need for continuous technological advancements and patient-centered care in radiotherapy.

Article Details

How to Cite
Saif Ur Rehman, Shafaq Maqsood, & Aneela Deevan. (2024). Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation. Journal of Health and Rehabilitation Research, 4(2), 461–465.
Author Biographies

Saif Ur Rehman, Ganga Ram Hospital Lahore Pakistan

Assistant Professor of Radiotherapy, Ganga Ram Hospital, Lahore, Pakistan

Shafaq Maqsood, Ganga Ram Hospital Lahore Pakistan

Senior Registrar, Oncology Department, Ganga Ram Hospital Lahore Pakistan

Aneela Deevan, Ganga Ram Hospital Lahore Pakistan

Medical Officer, Oncology Department, Ganga Ram Hospital Lahore Pakistan


Murthy V, Maitre P, Bhatia J, Kannan S, Krishnatry R, Prakash G, Bakshi G, Pal M, Menon S, Mahantshetty U. Late toxicity and quality of life with prostate only or whole pelvic radiation therapy in high risk prostate cancer (POP-RT): A randomised trial. Radiotherapy and Oncology. 2020 Apr 1;145:71-80.

Catucci F, Alitto AR, Masciocchi C, Dinapoli N, Gatta R, Martino A, Mazzarella C, Fionda B, Frascino V, Piras A, D’Aviero A. Predicting radiotherapy impact on late bladder toxicity in prostate cancer patients: an observational study. Cancers. 2021 Jan 6;13(2):175.

Wang K, Mavroidis P, Royce TJ, Falchook AD, Collins SP, Sapareto S, Sheets NC, Fuller DB, El Naqa I, Yorke E, Grimm J. Prostate stereotactic body radiation therapy: an overview of toxicity and dose response. International Journal of Radiation Oncology* Biology* Physics. 2021 May 1;110(1):237-48.

Parry MG, Nossiter J, Cowling TE, Sujenthiran A, Berry B, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Toxicity of pelvic lymph node irradiation with intensity modulated radiation therapy for high-risk and locally advanced prostate cancer: a national population-based study using patient-reported outcomes. International Journal of Radiation Oncology* Biology* Physics. 2020 Dec 1;108(5):1196-203.

Murthy V, Adsul K, Maitre P, Singla A, Singh P, Panigrahi G, Raveendran V, Phurailatpam R. Acute and Late Adverse Effects of Prostate-Only or Pelvic Stereotactic Radiation Therapy in Prostate Cancer: A Comparative Study. International Journal of Radiation Oncology* Biology* Physics. 2022 Oct 1;114(2):275-82.

Pepin A, Aghdam N, Shah S, Kataria S, Tsou Jr H, Datta S, Danner M, Ayoob M, Yung T, Lei S, Gurka M. Urinary morbidity in men treated with stereotactic body radiation therapy (SBRT) for localized prostate cancer following transurethral resection of the prostate (TURP). Frontiers in Oncology. 2020 May 5;10:555.

Houben J, McColl G, Kaanders JH, Smeenk RJ. Patient reported toxicity and quality of life after hypofractionated high-dose intensity-modulated radiotherapy for intermediate-and high risk prostate cancer. Clinical and Translational Radiation Oncology. 2021 Jul 1;29:40-6.

Magli A, Farneti A, Faiella A, Ferriero M, Landoni V, Giannarelli D, Moretti E, de Paula U, Gomellini S, Sanguineti G. Toxicity at 1 year after stereotactic body radiation therapy in 3 fractions for localized prostate cancer. International Journal of Radiation Oncology* Biology* Physics. 2021 Sep 1;111(1):93-100.

Mylona E, Cicchetti A, Rancati T, Palorini F, Fiorino C, Supiot S, Magne N, Crehange G, Valdagni R, Acosta O, de Crevoisier R. Local dose analysis to predict acute and late urinary toxicities after prostate cancer radiotherapy: Assessment of cohort and method effects. Radiotherapy and Oncology. 2020 Jun 1;147:40-9.

Jorgo K, Polgar C, Major T, Stelczer G, Herein A, Pocza T, Gesztesi L, Agoston P. Acute and late toxicity after moderate hypofractionation with simultaneous integrated boost (SIB) radiation therapy for prostate cancer. A single institution, prospective study. Pathology & Oncology Research. 2020 Apr;26:905-12.

Reinikainen P, Kapanen M, Luukkaala T, Kellokumpu-Lehtinen PL. Acute side-effects of different radiotherapy treatment schedules in early prostate cancer. Anticancer research. 2022 May 1;42(5):2553-65.

Juarez JE, Romero T, Mantz CA, Pepin A, Aghdam N, Suy S, Steinberg ML, Levin-Epstein RG, Nickols NG, Kaplan ID, Meier RM. Toxicity after stereotactic body radiation therapy for prostate cancer in patients with inflammatory bowel disease: A multi-institutional matched case-control series. Advances in Radiation Oncology. 2021 Nov 1;6(6):100759.

Christiansen RL, Dysager L, Hansen CR, Jensen HR, Schytte T, Nyborg CJ, Bertelsen AS, Agergaard SN, Mahmood F, Hansen S, Hansen O. Online adaptive radiotherapy potentially reduces toxicity for high-risk prostate cancer treatment. Radiotherapy and Oncology. 2022 Feb 1;167:165-71.

David RV, Kahokehr AA, Lee J, Watson DI, Leung J, O’Callaghan ME. Incidence of genitourinary complications following radiation therapy for localised prostate cancer. World journal of urology. 2022 Oct;40(10):2411-22.

Tree AC, Ostler P, van der Voet H, Chu W, Loblaw A, Ford D, Tolan S, Jain S, Martin A, Staffurth J, Armstrong J. Intensity-modulated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): 2-year toxicity results from an open-label, randomised, phase 3, non-inferiority trial. The Lancet Oncology. 2022 Oct 1;23(10):1308-20.

Qi X, Li HZ, Gao XS, Qin SB, Zhang M, Li XM, Li XY, Ma MW, Bai Y, Li XY, Wang D. Toxicity and biochemical outcomes of dose-intensified postoperative radiation therapy for prostate cancer: results of a randomized phase III trial. International Journal of Radiation Oncology* Biology* Physics. 2020 Feb 1;106(2):282-90.

Nuijens AC, Oei AL, Bouhuijs A, Franken NA, Rasch CR, Stalpers LJ. A comparison between patient-and physician-reported late radiation toxicity in long-term prostate cancer survivors. Cancers. 2022 Mar 25;14(7):1670.

Alayed Y, Quon H, Ong A, Cheung P, Chu W, Chung H, Vesprini D, Chowdhury A, Panjwani D, Pang G, Korol R. Accelerating prostate stereotactic ablative body radiotherapy: Efficacy and toxicity of a randomized phase II study of 11 versus 29 days overall treatment time (PATRIOT). Radiotherapy and Oncology. 2020 Aug 1;149:8-13.

Glicksman RM, Liu SK, Cheung P, Vesprini D, Chu W, Chung HT, Morton G, Deabreu A, Davidson M, Ravi A, Musunuru HB. Elective nodal ultra hypofractionated radiation for prostate cancer: Safety and efficacy from four prospective clinical trials. Radiotherapy and Oncology. 2021 Oct 1;163:159-64.

Schumacher O, Luo H, Taaffe DR, Galvao DA, Tang C, Chee R, Spry N, Newton RU. Effects of exercise during radiation therapy on physical function and treatment-related side effects in men with prostate cancer: a systematic review and meta-analysis. International Journal of Radiation Oncology* Biology* Physics. 2021 Nov 1;111(3):716-31.