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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Overview of cancer treatments Cryosurgery

HDR brachytherapy uses seeds made of iridium-194

that are contained inside soft catheters. The catheters

are removed after radiation has been given. This

treatment requires staying in the hospital for 1 to 2

days. HDR brachytherapy may be given along with


Side effects of radiation therapy

Similar to surgical treatment, a common side effect

of EBRT and brachytherapy is erectile dysfunction.

Unlike surgery, erectile dysfunction may develop

several years after radiation therapy. Although not

as common as erectile dysfunction, other sexual

changes may include difficulty achieving orgasm,

thicker semen, dry orgasm, discolored semen, and

a decreased sperm count. These less common side

effects often stop after a short period of time.

You may develop urinary problems. Urinary problems

right after EBRT may include frequent urination,

a burning feeling while urinating, blood in urine

(hematuria), and feeling the need to rush to a

bathroom or you’ll leak urine (urge incontinence).

After brachytherapy, you may have burning with

urination, a slow or weak urinary stream, urinary

retention, overflow incontinence, and hematuria.

These side effects go away. Several years later,

radiation injury to the bladder can cause urinary

incontinence, although this isn’t common for either

EBRT or brachytherapy. However, your risk after

brachytherapy is higher if you have had a TURP.

Despite the best treatment planning and delivery,

your rectum will be exposed to some radiation

during EBRT or brachytherapy. You may have rectal

pain, diarrhea, blood in the stool, and inflammation

of the colon. These side effects will go away over

several months. Several years later, radiation injury to

the rectum can cause rectal bleeding and irritation but

these symptoms are rare.

EBRT may cause changes in your skin. Your treated

skin will look and feel as if it has been sunburned. It

will likely become red and may also become dry and

sore and feel painful when touched. You may also feel

extremely tired despite sleep (fatigue) and not feel

hungry. Exercise may help reduce fatigue.

Not all side effects of radiation therapy are listed here.

Please ask your treatment team for a complete list of

common and rare side effects. If a side effect bothers

you, tell your treatment team. There may be ways to

help you feel better.


Cryosurgery is a treatment option if radiation therapy

fails. Cryosurgery treats prostate tumors by freezing

them. This treatment is often done as an outpatient


Very thin needles will be inserted through your

perineum into your prostate. Imaging tests will be

used to place the needles. Argon gas will flow through

the needles and freeze your prostate to below-zero

temperatures. Freezing kills the cancer cells. Your

urethra will be spared by use of a catheter filled with

warm liquid.

The full range of side effects from cryotherapy is

unknown. More research is needed. Known short-

term side effects include urinary retention, painful

swelling, and “pins and needles” feeling in the penis

(penile paresthesia). Long-term side effects include

erectile dysfunction, stress incontinence, fistulas, and

blockage of the urethra with rectal scar tissue.