Asymptomatic Bladder Stones Exacerbate Acute Genitourinary Adverse Events During Radiation Therapy for Prostate Cancer: Insights From Two Case Reports

<h2>Abstract</h2><h3>Background</h3> Radiotherapy is a standard treatment for prostate cancer, but it can cause genitourinary (GU) toxicities, such as hematuria, dysuria, urinary retention, and increased urinary frequency. Pre-existing bladder stones may worsen these toxicities, potentially resulting in significant treatment interruptions. <h3>Case Presentation</h3> Here, we report two cases of acute grade 3 GU toxicities that occurred during radiotherapy in patients with prostate cancer and preexisting asymptomatic bladder stones. The first involved a 77-year-old man who developed acute GU toxicities during intensity-modulated radiotherapy (IMRT). His symptoms improved after an 8-day treatment pause and urinary catheterization. Bladder stone removal was performed after the completion of radiotherapy. The second case involved a 79-year-old man whose GU toxicities were resolved following endoscopic bladder stone removal and a 43-day treatment pause. Both patients exhibited favorable prostate-specific antigen (PSA) responses, with no symptom recurrence within six months post-treatment. <h3>Conclusion</h3> These cases underscore the importance of addressing bladder stones before initiating radiotherapy, even if they are asymptomatic. Proactive management may reduce the risk of severe genitourinary toxicities, prevent treatment delays, and improve overall outcomes. Further studies are required to establish guidelines for the management of bladder stones in patients with prostate cancer undergoing radiotherapy.