brand logo

Am Fam Physician. 2016;94(6):418

Original Article: Prostate Cancer Screening

Issue Date: October 15, 2015

See additional reader comments at: https://www.aafp.org/afp/2015/1015/p683.html

to the editor: In their cautionary review of prostate cancer screening, Mulhem and colleagues did not mention a potentially life-threatening long-term complication of radiation treatment. Symptomatic hematuria occurs in 2.1% to 8.2% of patients treated with external beam radiation or brachytherapy.1 The pathophysiology is chronic fibrosis and progressive endarteritis, which cause sloughing of the bladder mucosa and bleeding that may occur many years after treatment. These patients can suffer greatly from urinary frequency, dysuria, urgency, incontinence, blood clots, obstruction, catheterization, irrigation, cauterization, or transfusion. Radiation cystitis is one of the most common diseases I treat as medical director of a hospital-based hyperbaric medicine facility. A retrospective review of 60 patients who received an average of 33 hyperbaric oxygen therapy (HBOT) treatments showed that 80% of patients had total or partial resolution of hematuria. When HBOT was started within six months of hematuria onset, 96% had total or partial resolution of symptoms.1 The treatment consists of breathing 100% oxygen in a single-place or multi-place pressure chamber at 2.4 atmospheres absolute for 90 minutes. Contraindications are few, and significant complications are rare, even in older patients. It is important for family physicians to know about the effectiveness of HBOT for soft tissue radionecrosis and for them to inform affected patients about this important treatment modality.

in reply: The main goal of our article was to review the current evidence for prostate cancer screening. We did mention common complications associated with treatment of prostate cancer. Because the focus of the article was screening, we did not focus in depth on the complications of treatment. Although HBOT is one of the many available treatments for hemorrhagic radiation cystitis, conservative management continues to be the best option.1

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Continue Reading


More in AFP

More in PubMed

Copyright © 2016 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.