Salvage Radiation Proctitis

[dans_journey]

I underwent 35 sessions (70 Gy) of IMRT salvage radiation therapy (SRT) to my prostate bed only in July and August 2022.

Now, 27 months after the radiation ended, I am seeing traces of blood in my stools about 10% of the time. There were a couple of instances where the spots were more noticeable. The size and frequency of this happening seem to be diminishing slightly over time.

I understand that this can be a long-term side effect from the SRT, and I've emailed my radiation oncologist to get his perspective on it. I'm awaiting his response.

I mentioned it to my primary care physician during a routine check-up on Monday, and he has scheduled a colonoscopy to check out what may be happening. I meet with the urologist next Thursday (14 NOV), and will discuss it there, too.

My questions for the group if you have experienced something similar:

- Is this something to be overly concerned about?

- Is a colonoscopy appropriate in this situation?

- Is there risk that the colonoscopy could further damage/aggravate the problem?

- Anything else I should know about/consider?

Thankfully, I haven't experienced other long-term side effects like diarrhea or mucus discharge, and I hope I won't.

Thanks in advance!

[vintage42]

"... My questions for the group... Is a colonoscopy appropriate in this situation? Is there risk that the colonoscopy could further damage/aggravate the problem?"

Evidently there is some concern about the effect of radiation on the bowels vs poking around in there with the scope, even without proctitis, so discuss with the gastroenterologist. MSK says "Avoid having a colonoscopy for the first year after radiation therapy." mskcc.org/pdf/cancer-care/p...

When I had my last colonoscopy in 2019 at age 76, I was told I was in good enough condition to have another in 5 years, when I would be 81. So this year I received a questionnaire in preparation for that, and put down that I had prostate radiation in 2021 and pelvic radiation in 2023 with no after effects. Nevertheless, I did not get any follow up to have another colonoscopy.

[dans_journey in reply to vintage42]

Thanks for your insights and the link. I'm 27 months out from the end of SRT, so hopefully that's long enough.

[Vynbal]

I had primary (proton) RT in August 2021 and was told to avoid colonoscopy for at least 1 year, preferably 2 and if done to particularly avoid a rectum biopsy as this can lead to a fistula. I did have a colonoscopy in Jan 2023 - 17 months after RT with no problem. I also had some minor late stage proctitis. It was treated with a few days of hydrocortisone suppositories.

[dans_journey in reply to Vynbal]

Thanks for sharing your experience. I'm 27 months out from the end of radiation, so that should work in my favor.

[tunybgur]

I would say a colonoscopy would be the most appropriate action in this case. You need to confirm there is nothing more sinister going on.

More than 2 years after RT seems a long time for SE's to start appearing but it's not unknown.

I've also been having 'slightly' bloody stools 8 months after RT and have just had a colonoscopy, it's no big deal and relieves concern about possible nasties. Mine are due to radiation proctitis aggravated by historic scars from diverticulitis.

I keep asking how long these SE's go on for but nobody seems to know, their progression seems to be an individual thing, some people have them for good, others a few months.....

Good luck, the colonoscopy is nothing to fear and should relieve any concerns.

[dans_journey in reply to tunybgur]

Thanks for sharing. Yeah, I've had two colonoscopies prior to radiation, so I know what I'm in for. The worst part is the prep. Ugh.

[dans_journey]

Thanks to all who have replied so far. Since posting this, I have come across this paper that gives a good overview of radiation proctitis, its diagnosis, evaluation, and possible treatment. I'll post the link here in case others are following along.

ncbi.nlm.nih.gov/books/NBK5...