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    Salvage radiation side effects
    virus56 posted:
    I am 3.5 wks into an 8 wk course of salvage IMRT radiation and have been experiencing constant diarrhea (at time very painful) since the end of the first week. I realize that diarrhea is a common side effect, but this seems a bit extreme and I am concerned about permanent damage. Have others experienced this and if so how long after the radiation concluded do the symptoms persist? Doctors give me the standard answer available in most medical journals and website, but I am interested in responses from guys that have had salvage IMRT radiation.
    Thanks for any help.
    Fairwind responded:
    What type of linac (linear accelerator) is being used? Where are you being treated? When you start getting SEVERE side-effects, it's time to start asking questions..Most men being treated for prostate cancer either salvage or primary, suffer very mild side-effects..Modern linacs can direct the radiation to avoid damage to nearby healthy tissue..The machine treating you has been programed according to your treatment plan written by the radiation oncologist. You might ask that a second R-doc review that plan to be sure there are no mistakes or problems..
    Galileo1962 responded:
    Hi virus56.
    I had salvage radiation in 2007, and experienced similar side effects, although later in the course of treatment. I was given a prescription for Proctofoam, which took care of the painful bowel movements, and I controlled the diarrhea with Imodium (over the counter). I also changed my diet to a "low residue" diet temporarily, which helped.
    I have read a lot about salvage radiation, and the side effect in question, which is acute radiation proctititis. There is another variety of proctitis, chronic. Chronic usually occurs sometime after treatment ends, and is difficult to treat. The acute kind that you and I experienced is generally self-resolving (goes away on its own) in a matter of weeks or months after the radiation treatments are finished. That doesn't mean you won't also experience chronic proctitis, but cross that bridge if and when it comes.

    In the meantime, I would see if you can get help from your doctor in managing the symptoms.
    As far as permanent damage, I don't know if having acute proctitis means that we are more likely to have a secondary tumor, but that would seem logical. Overall, just having salvage radiation increases our odds of developing rectal and/or bladder cancer down the road. Whether the proctitis indicates stronger risk--again, I don't know.
    But we do know that we had prostate cancer, our PSAs were rising, and that salvage radiation offers the last curative chance we had. So--hang in there. Salvage doesn't work for everyone, and for those it works it doesn't necessarily work forever, but it seems possible that at least a portion of men are cured by it.
    In my case, my PSA is stable and undetectable on the standard assay (less than 0.1), now over 4 years out from the end of radiation. My bowel situation is a little different than pre-radiation, but I'm not complaining, much. I seem to be more prone to gas, less tolerant of dairy, and I pass a little mucus sometimes when I mean to just pass gas. (There was a jokey discussion thread recently on HealingWell about "never trust a fart" after radiation.)

    That means to me that there is probably some lingering inflammation, but it is not enough to cause me pain or diarrhea.
    I'll get a closer look in a few months when I have my first colonoscopy (50th birthday coming up.)

    Keep your chin up, and best wishes for a successful outcome.
    barryhoff replied to Galileo1962's response:
    Your post gave me experienced info I have not yet been able to obtain. Thanks. Couple questions. I am 61 yrs old. Ended salvage radiation 1 week ago. 36 treatments. I can be active for about 4 hrs, then get very tired. Will this get better quick ? Should I be as active as possible? Anything I should know to hasten recovery?
    1nwmike replied to barryhoff's response:
    I am also 61 and had salvage radiation 11 years ago. Yes, your energy level will improve but it won't be overnight. Yes, definitely stay active, as much as you can handle. Drink lots of water, good for your system and good for your bladder. For me I found that caffeinated drinks including soft drinks made me have more bladder leakage. Good luck to you on your recovery. -Mike in Seattle

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