hemorroids before EBRT for PCa

[Kroll2013]

Is the presence of symptomatic hemorrhoids considered a contra-indication for radiation treatment for prostate cancer?

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[Radiator20]

Is the presence of symptomatic hemorrhoids considered a contra-indication for radiation treatment for prostate cancer?

I wouldn’t think so. But they might well worsen on tx, particularly if your institution uses daily rectal balloon.

If they’re truly bothersome (and you’re worried about ability to get through tx for that reason), could consider asking a general surgeon to take care of them first. If he has lower risk disease, the delay won’t matter, and if higher risk disease, will be on neoadj ADT anyway so you’ve got some time.

In addition, could BB anal verge at time of sim and make a special effort to keep dose off it (while not undercovering).

 

[scarbrtj]

If the hemorrhoids are in the XRT field, in this day and age, we're doing it wrong.

But they might well worsen on tx, particularly if your institution uses daily rectal balloon

Ha!

 

[medgator]

Ha!

Made me lol too... I wonder if anyone still does it

 

[Radiator20]

If the hemorrhoids are in the XRT field, in this day and age, we're doing it wrong.

Agree, certainly they shouldn’t be in PTV. But doesn’t mean they won’t see any dose. And if hemorrhoids are bad enough that we’re having this discussion, I think it’s worth paying attention to that dose.

Made me lol too... I wonder if anyone still does it

Yup. Some still do. The argument, I think, being better overall setup but particularly less posterior uncertainty, so smaller posterior PTV and ultimately better rectal sparing. Not necessarily endorsing, just saying.

 

[CptCrunch]

I wouldn’t think so. But they might well worsen on tx, particularly if your institution uses daily rectal balloon.

If they’re truly bothersome (and you’re worried about ability to get through tx for that reason), could consider asking a general surgeon to take care of them first. If he has lower risk disease, the delay won’t matter, and if higher risk disease, will be on neoadj ADT anyway so you’ve got some time.

In addition, could BB anal verge at time of sim and make a special effort to keep dose off it (while not undercovering).

Agreed. Probably best to take care of it before treatment so you won't hear complaints about it each week during OTVs.

 

[Palex80]

Put the patient on ADT, take care of the hemorroids, treat PCA later.