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However this trial also confirmed an increase in rectal side effects in the higher dose arm (grade 2 or higher toxicity: 26% versus 12%).
In a study by Goldner et al. [ 29], 52 patients were reported with grade 2-3 EORTC/RTOG late rectal side effects - the reason was rectal bleeding for 50 patients (96%).
In light of these findings, the patient's dilemma is made that much more profound by the significant rates of genitourinary and rectal side effects, which can occur despite technological improvements in surgery and radiation [2 5].
In conclusion, dose escalation from 64 to 74 Gy using conformal radiotherapy may improve long-term PSA control, but a treatment margin of 1.5 cm is unnecessary and is associated with increased acute bowel and bladder reactions and more late rectal side effects.
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Practical barriers may include complex dosage regimens, the size of tablets, the cost of prescriptions, the route of delivery (e.g. rectal or oral) and side effects.
After 2 years of follow-up, RTOG grade ⩾2 side effects were seen as follows: rectal bleeding 16, rectal discomfort three, bowel frequency three, and day time urinary frequency 10, nocturia seven, dysuria one, haematuria one, urinary incontinence three and urethral dilatation two.
Common side effects following cryotherapy include rectal or perineal discomfort [ 49] and urinary infections [ 50].
Hypofractionated short course radiation regimens can overcome this limitation and have shown equal benefit in terms of local control with less acute side effects for example in rectal cancer [ 12, 19, 20].
5-FU is one of the most prescribed drugs in clinical oncology for colo-rectal cancer patients [ 18, 19], however side effects are often reported, leading to compliance failure.
The nation's preeminent doctors furiously debate the relative efficacy of these alternatives, but the treatments all come with the potential for nasty side effects, ranging from incontinence to rectal bleeding.
Reduced side effects were also reported for rectal separation by transperineal injected collagen and prostate IMRT without radiation dose-escalation [ 12].
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