Radiation Burn and Other Cancers

First of all there is a lot of "horror" stories about the damage done to your body and other organs during radiation (of any kind) to the prostate. The prostate is located between the rectum and the bladder - both of which may get radiation. This is where the expertise of the Radiation Oncologist comes to play. With proper mapping and being able to follow the prostate when it moves is important to the overall cure and radiation burn of other organs.

The newer methods of external beam radiation are called IMRT (Intensity Modulated RadioTherapy). There are a number of "offshoots" of this but still in the same category. The fine control the doctor has of the beam is the clue. The doctor can take a wide sweep of the area in the hope of getting all the cancer or he can narrow the beam to include the prostate and exclude the surrounding area. This is not to say the surrounding area does not get radiation but simply to say that it only gets what might have spread from the radiation to the gland. However this is not usually enough to cause radiation burn or problems with urination, etc. But the skill of the doctor is all important here. The higher the skill the less damage to the surrounding area.

A little known fact among patients is that the prostate gland moves. It actually can move up to about 1cm in any direction at any time dependant on breathing, a full bladder, a full colon, etc. In addition to this movement patients frequently have undiagnosed ECP (Extra Capsuler Penetration) or ECE (Extra Capsuler Extension). These are little nubs that are cancer that is pushing out from the prostate gland itself. Now this is not necessarily a spread of the disease outside the local area (metastatic cancer) but it does show a good chance the cancer may have spread.

Therefore when the external beam radiation is done one has to allow for the movement plus any ECE. This means the beam has to spread over an area wider than the prostate gland - and this may mean radiating some of the other organs. This may well be an area where the doctor does not leave adequate beam around the gland and you get recurrence. If the doctor is experienced in giving radiation to the prostate area he knows where he can fudge and not give a full does and where he believes may leave side effects.

In the terms of Brachytherapy (seed implants, either permanent or temporary) you really have the best most precise radiation to the gland that is possible - radiating from the inside out. Again the expertise of the doctor comes into play. Simply if he does not have the experience to not place seeds in areas that will burn other organs - then he burns. It actually is a very complicated procedure to place adequate seeds where you have cancer and reduce the dose in areas not likely to have cancer. To me it is IMRT at its best but IMRT only applies to External Beam Radiation.

How can you know which doctor has the best (or worse) record of side effects. Unfortunately you can't unless the doctor has published, in a peer reviewed journal, his record along with his side effects. But most doctors will not do this - they simply tell you everything will be OK or they tell you nothing. Simply only take what the doctor says with a grain of salt - knowing that he will make money doing the procedure and that frequently is more important than telling the patient the facts. If he does not trace his patients for studies - he really does not know the facts. I know doctors who have published their results and yet in a meeting with patients they always say their results are around 10 points higher that the published paper. He knows that few will ever question and if they do - he has a canned presentation that would make the best talking salesman you ever met - seem like a novice. Don't ever forget that money drives this business at all levels.

Then you learn the problems after the procedure is done. Some doctors may measure these side effects differently. For example does being impotent mean that you can not get an erection, you cannot hold n erection, it takes Viagra or similar drugs to get an erection. Doctors may use any of these but usually in studies they decide you are not impotent if you can get an erection with Viagra or similar drugs or other mechanical means. To me, at least, my definition would be you are impotent if you cannot get an erection without aids of any kind that last long enough to complete the sex act with you partner. But this figure would be too high and the doctors want to lower the impotency rate so they dig up other definitions.

Only with studies published in peer reviewed journals do you ever know anything about the side effects of any doctor and the same goes for the results. If you are handed a slick brochure or white paper from your doctor giving you his results - ask them where they are published. If they are not peer reviewed published studies - they really are not worth the paper they are published on. Even when you read the full study and really understand the published studies and how they work - you may be mislead. Sometimes it seems the doctors are trying to confuse you with words, etc. to hide the real truth.

Now with all of this said it seems that we have some people who will burn more easier than others. These people may well report burns even with the best and most experienced of docs. Just because someone reports major problems they have had with a procedure does not necessarily mean that the doctor did a bad job. If you could find out how many had this problem you might be able to say "bad doctor" but this kind of doctor will never let you know how often he has bad results. They believe they are all experts on level with anyone else.

As for damage done that may cause other cancers later there is some evidence that this may be so - but the cancers that are caused are created many years out - years that many of us will be gone from other causes. To me this was so far outside that it was not a consideration when I chose to have Brachytherapy followed by External Beam Radiation.