Radiation therapy is known to achieve treatment outcomes comparable to surgery in cases of localized prostate cancer and locally advanced prostate cancer. However, due to the anatomical characteristic that the prostate is located directly beneath the bladder, the bladder can also be exposed to a certain amount of radiation when the pelvic region is irradiated. As a result, some patients may develop radiation cystitis, particularly hemorrhagic cystitis accompanied by bleeding, several months to several years after treatment, thus requiring caution.
According to a paper published by Dr. Pavlidakey's research team in the international journal Journal of Urology in 2009, among others, approximately 5-10% of patients who received prostate cancer radiation therapy develop cystitis as a late complication 1-2 years later. Radiation cystitis at this stage goes beyond simple inflammation and shows a pattern of structural damage to the bladder mucosa and blood vessels. Due to this, much like interstitial cystitis, the bladder wall becomes eroded and microvessels proliferate, exhibiting a characteristic tendency to bleed easily.
Radiation, in the process of cutting the DNA of cancer cells and inhibiting cell division, affects surrounding normal tissues. Bladder tissue is a structure particularly sensitive to radiation; as mucosal cells and the muscle layer are damaged and blood vessel walls weaken, this leads to decreased local blood flow and hypoxia. If these changes accumulate over a long period, bladder mucosal necrosis, microvessel rupture, and chronic inflammation can follow, causing persistent symptoms such as frequent urination, dysuria (painful urination), residual urine sensation, and hematuria (blood in urine). In severe cases, it can lead to situations where urine is blocked by blood clots, requiring an emergency room visit or blood transfusion.
The treatment for hemorrhagic cystitis involves various methods such as bladder irrigation, endoscopic fulguration, and pharmacotherapy, depending on the severity of symptoms. However, tissues damaged by radiation tend to have a slow recovery rate and frequent recurrence. In this context, a recently highlighted treatment is 'intravesical drug instillation therapy'. Similar to a paper published by Dr. Giannitsas's research team in Current Urology, there is a growing number of research cases confirming significant improvement effects such as reduced dysuria, decreased frequency of urination, and increased voided volume per micturition when drugs are instilled into the bladder of patients with an eroded bladder wall after radiation therapy.
The procedure is performed by inserting a catheter into the bladder, instilling the drug, and maintaining it for at least 30 minutes. Initially, it is generally repeated once a week, and thereafter, every other week. For patients who show an insufficient response to conventional treatments or suffer from chronic radiation cystitis, it is characterized by being relatively safe and less burdensome.
As such, cystitis after prostate cancer treatment is a complication requiring a therapeutic approach. Because it occurs several years after radiation therapy, patients often do not recognize the connection with their treatment themselves. Experts emphasize that during post-prostatectomy management and post-radiation therapy follow-up, early detection and systematic management of urological side effects such as radiation cystitis and hemorrhagic cystitis significantly impact the quality of life.
Dr. Ryu Kyung-ho, director of Goldman Urology Gangnam Branch, stated, "With the recent introduction of various evidence-based treatments, including intravesical drug instillation therapy, long-term management of post-radiation cystitis is gradually becoming possible," and advised, "Even if symptoms are mild, seeking early medical attention and starting treatment helps reduce recurrence and improve long-term prognosis."