Radiation therapy is known to show comparable treatment outcomes to surgery in cases of localized prostate cancer, locally advanced prostate cancer, and similar conditions. 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 other studies, approximately 5-10% of patients who undergo radiation therapy for prostate cancer develop cystitis as a late complication 1-2 years later. Radiation cystitis during this period manifests as structural damage to the bladder mucosa and blood vessels, going beyond simple inflammation. Consequently, the bladder wall becomes eroded and microvessels proliferate, leading to easy bleeding, much like in interstitial cystitis.
Radiation affects surrounding normal tissues in the process of cutting the DNA of cancer cells and inhibiting cell division. Bladder tissue is a structure particularly sensitive to radiation, leading to damage to mucosal cells and the muscular layer, weakening of blood vessel walls, and subsequent local blood flow reduction and hypoxia. If these changes accumulate over a long period, they can lead to bladder mucosal necrosis, microvessel rupture, and chronic inflammation, resulting in persistent symptoms such as frequent urination, painful urination, a sensation of incomplete bladder emptying (residual urine sensation), and hematuria. In severe cases, blood clots can obstruct urine flow, necessitating an emergency room visit or even blood transfusions.
Treatment for hemorrhagic cystitis involves various methods depending on the severity of symptoms, including bladder irrigation, endoscopic cauterization, and pharmacotherapy. However, tissues damaged by radiation tend to have a slow recovery rate and frequent recurrence. In this context, a recently gaining attention treatment is 'intravesical drug instillation therapy'. There is a growing number of research cases, such as a paper published by Dr. Giannitsas's research team in Current Urology, confirming significant improvement effects like reduced painful urination, decreased frequency of urination, and increased single voided volume when drugs are instilled into the bladder of patients with eroded bladder walls after radiation therapy.
The procedure involves inserting a catheter into the bladder, instilling the medication, and maintaining it for at least 30 minutes. Initially, it is typically repeated once a week, and subsequently, every other week. It is characterized by being relatively safe and less burdensome for patients who show an inadequate response to conventional treatments or suffer from chronic radiation cystitis.
As such, cystitis following prostate cancer treatment is a complication that requires a therapeutic approach. Since it often occurs several years after radiation therapy, patients themselves frequently do not recognize its connection to the treatment. Experts emphasize that early detection and systematic management of urological side effects such as radiation cystitis and hemorrhagic cystitis during post-prostatectomy care and post-radiation therapy follow-up 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 treatment methods, including intravesical drug instillation therapy, long-term management of post-radiation cystitis is gradually becoming possible." He advised, "Even if symptoms are mild, seeking early medical attention and starting treatment helps reduce recurrence and improve long-term prognosis."