Management of Dizziness After Prostatectomy and Radiation Therapy
Dizziness is not a recognized side effect of prostatectomy or radiation therapy for prostate cancer, and when it occurs in this patient population, it should be evaluated as an independent medical concern unrelated to prostate cancer treatment. 1
Why Dizziness Is Not Treatment-Related
The comprehensive guidelines and evidence for post-prostatectomy and post-radiation complications do not identify dizziness as a sequela of these treatments. 1, 2
The established side effects of prostatectomy include:
- Stress urinary incontinence (14-25% at 10 years) 1
- Sexual arousal incontinence and climacturia (20-93%) 1
- Erectile dysfunction (100% after salvage surgery post-radiation) 3
- Urinary frequency and urgency from bladder dysfunction 4
The established side effects of radiation therapy include:
- Irritative urinary symptoms (frequency, urgency, dysuria) from mucositis and edema 1
- Long-term urinary stricture, hematuria, and decreased bladder capacity 1
- Anejaculation (11-72% depending on modality) 5
- Bowel dysfunction from radiation proctitis 6
Clinical Approach to Dizziness in This Population
Evaluate dizziness using standard diagnostic algorithms for the general population, as this symptom requires investigation for cardiovascular, neurologic, vestibular, or medication-related causes. 1
Key Differential Considerations
Medication-related causes should be prioritized:
- Anticholinergics (oxybutynin) used for urge incontinence can cause dizziness as a central nervous system side effect 1, 4
- Alpha-blockers used for obstructive symptoms can cause orthostatic hypotension 1, 4
- Androgen deprivation therapy (ADT) can contribute to fatigue and orthostatic changes 5
Cardiovascular evaluation is essential:
- Orthostatic vital signs to assess for postural hypotension 1
- Cardiac evaluation if indicated by history or examination 1
Age-related comorbidities must be considered:
- These patients are typically older men with multiple cardiovascular risk factors 1
- Polypharmacy is common in cancer survivors and increases dizziness risk 1
Management Algorithm
If the patient is taking anticholinergics or alpha-blockers for urinary symptoms, trial discontinuation or dose reduction to determine if these medications are causative. 1, 4
If dizziness persists after medication adjustment, proceed with standard workup including:
- Orthostatic blood pressure measurements 1
- Cardiovascular assessment 1
- Neurologic examination 1
- Vestibular function testing if indicated 1
Do not attribute dizziness to prostate cancer treatment without exhausting other diagnostic possibilities, as this may delay identification of serious underlying conditions. 1