title: Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?
abstract: BACKGROUND
  Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer.
  
  
  METHODS
  A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation.
  
  
  RESULTS
  Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed.
  
  
  CONCLUSIONS
  Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines.
authors.affiliation: North Coast Cancer Institute, Coffs Harbour, Australia. Electronic address: Myo.Min@health.sa.gov.au.
authors.forename: Myo
authors.initials: M
authors.lastname: Min
authors.affiliation: North Coast Cancer Institute, Coffs Harbour, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chua
authors.affiliation: Coffs Harbour Hospital, Australia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Guttner
authors.affiliation: Coffs Harbour Hospital, Australia.
authors.forename: Ned
authors.initials: N
authors.lastname: Abraham
authors.affiliation: North Coast Cancer Institute, Coffs Harbour, Australia.
authors.forename: Noel J
authors.initials: NJ
authors.lastname: Aherne
authors.affiliation: North Coast Cancer Institute, Port Macquarie, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: North Coast Cancer Institute, Lismore, Australia. Electronic address: Michael.McKay@ncahs.health.nsw.gov.au.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McKay
authors.affiliation: North Coast Cancer Institute, Coffs Harbour, Australia.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shakespeare
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology*; D007422:Intestines / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010388:Pelvis / Q000528:radiation effects; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods
keywords: Bowel symptoms; Endoscopic examination; IMRT; Prostate cancer; Radiation proctopathy