Complications of prostate cancer treatment: spectrum of imaging findings

Abstract

The imaging appearances of prostate cancer are well described in the radiology literature, but little has been written about the detection and appearance of the complications of therapy for this disease. The most frequently used treatments for prostate cancer are surgical therapy (eg, radical retropubic prostatectomy, radical perineal prostatectomy), radiation therapy (eg, brachytherapy, external-beam radiation therapy, three-dimensional conformal radiation therapy, intensity-modulated radiation therapy), and cryoablative therapy, each of which may lead to complications with characteristic imaging appearances. Possible complications include lymphocele formation; injuries to the ureter, rectum, and urethra; prostatic necrosis; vesicourethral anastomotic leak and stricture; urethral stricture, necrosis, and fistula; radiation proctitis; transient bladder outlet obstruction; radiation-induced urethritis; urinary incontinence; and erectile dysfunction. With improvements in surgical techniques and advances in technology, complications of therapy for prostate cancer are decreasing but still occur with sufficient frequency to warrant familiarity on the part of radiologists. Knowledge of the diverse spectrum of these complications and their characteristic radiologic features facilitates prompt diagnosis and treatment.