My doctor seems to think that a course of 9 weeks of IMRT on my Lymph node area and prostate to treat prostate cancer is not likely to cause incontinence for me.
I'm 60 and I'm not sure he is right.
When I think of causing incontinence I am concerned also in the long run. If in 10 years I would have incontinence. What is it that radiation can do to cause incontinence? Is my doctor right that in an otherwise healthy 60 year old individual incontinence is unlikely?
Yes, your doctor is right. Incontinence is a very rare side effect of radiation (about 2%) and even then it is usually in men who already have problems. You may experience frequency and urgency for a few weeks - when you gotta go, you gotta go. If you have brachy boost therapy (EBRT+seeds) about 20% experience urinary retention, which is the opposite problem.
It is rare because patients treated with radiation are left with the urethra inside the pelvis (prostatic urethra), which is normal anatomy.
Changes in the abdominal pressure pushing out the urine from the bladder will be compensated by the same increase in pressure in the prostatic urethra .
This does not happens in people with radical prostatectomy, since they are left with no urethra inside the pelvis. Increases in the abdominal pressure will push urine out of the bladder and they have to avoid leaking urine by contraction of the muscles in the perineum. This is the main reason many people with RP has stress incontinence.
Nice clear explanation Tango. 👍
The old pathophysiology.
First time I read about the connection with having prostatectomy. That's my husband's case. First RALP; 18 months later 39-IMRT sessions. A couple years later bleeding, various "fixes" only worsened & now total incontinence. Real blow. In his case, we'd have foregone IMRT for more/longer ADT+ His QOL is pretty awful.
Thanks for the connection to RP. I feel a lot better after these replies
I had RP in 2013 and SRT in 2014. Stress incontinence started about 6-7 years later and I’ve had total incontinence for the last few years . After failed sling and AUS Ihave been using Foley catheter since March 2023. And I experience leakage around catheter necessitating briefs and pads. My urologist says my urethra is full of scar tissue due to radiation. This is the first time I’ve heard that RP is the culprit.
I had RP in 2003 and since then I have stress incontinence which is becoming worse along the years, particularly since I am in ADT which is causing muscle atrophy.
The atrophy of the perineal muscles will lead to worsening of the incontinence since their tone is what is clossing the remaining urethra after a RP.
Unlikely but possible.
It wouldn't hurt to take trental for a few years or longer after the treatment.
I had salvage IMRT radiation last summer. I had urgency and slight incontinence for few weeks toward the end of the 8 week therapy that went away 2 weeks after completion. You should be fine.
I had a spaceoar put in. I had no issues urinary or bowel during and now 8 months after treatment. (I'm 61)
I too had SpaceOAR and while it may have helped to reduce any serious side effects from IMRT, both a subsequent colonoscopy and cystoscopy revealed photographic evidence of radiation-induced proctitis and cystitis respectively. This shows up as increased vascularity ("spider veins") in the respective tissues.
I was relatively young when diagnosed. People that didn't know me thought I was as much as 15 years younger than my age. My first uro looked at my stats from a comprehensive physical and looked at me. His advice was not to choose radiation as a treatment as it can, in the future, cause urinary and fecal incontinence.
Interesting and not many know this. Someone I emailed with, someone of note in my area, had, I believe, colon cancer. Radiation, some chemo and all was good. He asked an attractive young lady to do him the honor of becoming his wife. She accepted and he was elated. Within months an artery in his lower abdomen ruptured and he bled to death before it could be stopped. Did the radiation damage the artery? What about use of fluoroquinolones? Those of us who have been prescribed fluoroquinolones have twice the incidence of aortic aneurysms. I feel that for years, until a guv acronym agency posted a study about it, that when one of us had a problem it was brushed off as "aortic aneurysms happen to them when they get old".
One has to carefully weigh not only the choice of treatment but also consider the possibility of how the treatment chosen will affect or limit choices of treatment in the future in the event of a biochemical recurrence.
Over the years I have found that surgeons tout surgery as the best--if confined to the capsule. RO's--this is the best. The advice just continues --each think their type of treatment is the best right on down to charlatans and shysters who know what they tout isn't anything but a scam --unless the placebo effect somehow works--but they want your money.
Currumpaw
I would think the spaceOAR is a given. Still I'm not so sure.
After 25 sessions of IGRT and 2 sessions of HDR Brachy my RO, Chief of dept, told me incontinence is a long term effect but rare.
Age 60 and 5 months later no problems, at my follow up the RO was very optimistic about side effects further down the road
Highly recommend Spac-OR.
Incontinence
HDR boost Brachytherapy + IMRT
Incontinence but why? 
Incontinence after RP and ADT
