Pelvic radiotherapy in men - side effects during treatment
This information is for men who are having, or are about to have, radiotherapy to the pelvic area (lower part of the abdomen). Radiotherapy to the pelvis can cause side effects for some people. This information is about the possible side effects and how they can be controlled if they occur.
The pelvis is the area of the body between the hips, in the lower part of the tummy (abdomen). In men, it contains:
the prostate gland
the lower end of the large bowel (colon, rectum and anus)
part of the small bowel
lymph nodes (glands).
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to healthy cells. In men, pelvic radiotherapy can be used to treat cancer of the prostate gland, bladder, rectum or anus.
Radiotherapy can either be given from outside the body (externally) or from inside the body (internally). Some men are treated with a combination of both methods.
Your course of radiotherapy will be prescribed by a cancer specialist (clinical oncologist), a doctor who specialises in the use of radiotherapy and chemotherapy. The person who operates the machines and helps position you before each treatment is called a radiographer.
External radiotherapy is normally given as a series of short, daily treatments in the radiotherapy department at the hospital. It uses equipment similar to a large x-ray machine. Treatment is often given over several weeks as an outpatient. It’s most commonly given once a day from Monday-Friday, with a rest at the weekend.
Each treatment takes a few minutes and is painless. It won’t make you radioactive and it’s safe for you to be around other people, including children.
Internal radiotherapy gives a high dose of radiation to the area being treated, but only a low dose to the surrounding normal tissue. Internal radiotherapy involves placing a radioactive material (source) inside the body to give the treatment.
Internal radiotherapy may be given in two different ways:
A radioactive source is placed close to the area being treated for a short time, and is then removed. This treatment may be given either in a few separate treatments as an outpatient, or as an inpatient over a few days. This method may be used to treat anal, rectal or prostate cancer. When the radioactive source is removed, you‘re not radioactive and it’s safe for you to be with other people, including children.
Radioactive seeds are placed inside the body and remain there permanently. This is also known as brachytherapy. This method is most commonly used to treat prostate cancer. The radiation is released slowly and the radioactivity gradually fades over several months. Although there are radioactive seeds in your body, almost all the radiation goes into the part of your body being treated. The amount of radiation that leaves your body is extremely small, so there’s no risk to other adults who come into contact with you. However, for about two months after the treatment, children and pregnant women shouldn’t stay very close to you for long periods of time. It’s safe for them to be in the same room as you though. If you’re having this treatment, your cancer specialist, radiographer or specialist nurse will explain it in detail to you.
Some men find internal radiotherapy uncomfortable, and you may need to take painkillers. You’ll also be given antibiotics to prevent an infection.
Side effects of pelvic radiotherapy
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Radiotherapy destroys cancer cells in the treated area, but it can also have an effect on some of the surrounding normal tissue.
Radiotherapy affects people in different ways, so it’s difficult to predict exactly how you will react to it. The side effects you have will depend on different factors. These include the type of cancer you have, the dose of radiotherapy given and whether it’s external or internal radiotherapy. For example, radiotherapy to treat cancer of the rectum or anus is not likely to cause as much bladder irritation as radiotherapy to treat cancer of the prostate or bladder.
If you also have other types of cancer treatment, such as surgery, chemotherapy or hormone therapy, this can affect the side effects you have. Having chemotherapy at the same time as radiotherapy (called chemoradiation) may cause more severe side effects.
Your cancer specialist, specialist nurse or radiographer will explain the most likely side effects in your situation. Let them know about any concerns or questions you have. They’ll be able to explain how side effects can be treated and give advice on how to cope with them.
Most side effects are temporary and start a week or two into the treatment. They may continue to get worse for a couple of weeks after treatment, before they begin to get better. Side effects usually improve gradually over the next few weeks or more.
Occasionally, some side effects don’t completely go away, or side effects develop months or years later as a result of the radiotherapy. These are called long-term or late effects.
Side effects during radiotherapy
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During treatment, you may have some of the side effects explained here. It’s important to tell your radiographer, cancer specialist or specialist nurse if you do. They can give you advice on how to manage them and tell you about the treatments that can help.
Radiotherapy often makes you feel tired, especially towards the end of the course of treatment. The tiredness continues after the treatment has finished and may last for a few months. You’ll find that your energy levels will gradually improve. However, it can take a while to recover, so don’t be too hard on yourself.
There are some things you can do to help manage tiredness:
Pace yourself so you don’t overdo it and take regular rests.
If you’re able to, plan some physical activity into your day, such as going for a short walk. This will help to build up your energy levels.
Ask family and friends to help out, perhaps with things like household tasks and taking care of the children.
Make sure you get enough sleep.
We have more information about coping with tiredness (fatigue), keeping physically active during treatment and getting a good night's sleep.
Denton talks about coping with fatigue when he was having treatment for prostate cancer.
Effects on the skin
Sometimes, radiotherapy can cause a skin reaction in the area being treated. The skin may redden or get darker, and become dry, flaky and itchy. Towards the end of treatment, the skin sometimes becomes moist and sore, and there may be breaks in the skin, especially around the scrotum, back passage and groin.
Your radiographer or nurse will check your skin regularly. Tell them if your skin is sore or if you notice any other changes. They will assess your skin and may prescribe a cream or dressings to help. They can also prescribe painkillers, if needed.
Your radiographer or specialist nurse will tell you how to look after the skin in the treated area. They will usually give you the following advice:
Keep the skin in the area clean, washing it gently with lukewarm water and unperfumed soap, then carefully patting it dry with a clean, soft towel.
Avoid using talcum powder, shower gel or any scented products on the treated area, as these can irritate the skin.
Check with the radiographer or nurse before you put anything on the skin in the treated area.
When taking a shower, use a very gentle stream of lukewarm water. If you take a bath, don’t soak in the water for long.
Use a simple, unperfumed moisturiser on the skin such as aqueous cream.
Wear loose boxers or shorts made from cotton or silk, which won’t rub against the skin. Avoid wearing tight-fitting trousers.
If you shave, wax or use hair removal creams, wait until a few weeks after radiotherapy is over and any skin reaction has healed.
Avoid smoking, as this can make skin reactions worse.
Skin reactions may be at their worst up to two weeks after radiotherapy finishes, before beginning to improve. If you’re sore or are having any problems with your skin during this time, contact the radiotherapy department for advice.
You’ll need to protect the skin in the treatment area from the sun for the first year after radiotherapy. After this, the skin will remain sensitive to strong sunlight, so if it is ever exposed, you should always wear suncream with a high sun protection factor (SPF) of at least 30.
Pelvic radiotherapy may make your pubic hair (hair around your genital area) fall out. It should start to grow back again within a few weeks after radiotherapy finishes, but it may be thinner. Occasionally, hair loss can be permanent.
Pelvic radiotherapy can cause irritation and inflammation of the lining of the bladder. You may find that you have some of the following symptoms:
a need to pass urine often (frequency)
a need to pass urine during the night (nocturia)
a burning sensation when you pass urine (similar to cystitis)
a feeling that you can’t wait when you find you need to empty your bladder (urgency)
blood in your urine (haematuria)
leaking small amounts of urine (incontinence).
Your doctor can prescribe painkillers or anti-inflammatory drugs to ease these symptoms. A sample of your urine may be tested to make sure there’s no infection present. If you have an infection, your doctor will prescribe a course of antibiotics for you. There are also things you can do to help with these symptoms.
What you can do
Drink at least 2-3 litres of fluid a day - urine that’s concentrated irritates the bladder and makes symptoms worse, so drinking more reduces this.
Avoid drinks that can irritate the bladder. These include drinks containing caffeine (tea, coffee, cocoa, cola), alcohol, fizzy drinks, acidic drinks (fresh orange and grapefruit juice) and drinks with artificial sweeteners (‘diet’ or ‘light’ drinks).
Avoid smoking, which can make the symptoms of bladder irritation worse.
Let your nurse or radiographer know if you leak urine (incontinence).
If symptoms get worse, you have a high temperature, or you feel you can’t pass urine, contact the hospital straight away.
If you have incontinence, your nurse will take a urine sample to check for signs of infection. This is a common and easily treatable cause of incontinence. They may also arrange for you to have pads if needed and give you advice on looking after your skin. If the problem doesn’t settle within a few weeks, they can refer you to a continence specialist for advice and treatment.
Just Can’t Wait toilet card
If you need to go to the toilet more often, or feel that you can’t wait when you do want to go, you can get a card to show to staff in shops, pubs and other places. The card allows you to use their toilets without them asking awkward questions. You can get a card from the Bladder and Bowel Foundation.
Other urinary problems
As well as bladder irritation, radiotherapy for prostate cancer may cause irritation of the tube that carries urine from the bladder to outside the body (the urethra) and swelling of the prostate gland. In addition to symptoms such as urinary frequency and urgency, this can cause you to:
need to wait for the flow of urine to begin (hesitancy)
have a weak flow of urine
feel that you haven’t quite emptied your bladder.
Your doctor may prescribe anti-inflammatory drugs, steroids or alpha-blockers, which may help reduce these effects. Alpha-blockers such as tamsulosin (Flomax®), terazosin (Hytrin®) or doxazosin (Cardura®) are tablets that work by relaxing the muscle in the bladder and prostate gland.
During or after radiotherapy for prostate cancer, some men develop a sudden inability to pass urine. This is called acute urinary retention. It’s rare in men having external radiotherapy but it does sometimes occur after brachytherapy, particularly in men who had urinary symptoms before treatment and have a larger prostate gland.
Acute urinary retention is caused by the prostate gland swelling and blocking the urethra. It may be treated with drugs that reduce swelling such as steroids or anti-inflammatory drugs (NSAIDs), or by putting a tube (catheter) into the bladder for a short time. It’s important to contact your doctor if you’re unable to pass urine.
Bowel side effects
Pelvic radiotherapy can cause some of the following side effects:
loose stools, diarrhoea or sometimes constipation
a need to open your bowels urgently
cramping pains in your tummy (abdomen) or back passage
passing a lot of wind.
Some other, less common side effects are:
feeling as if you need to go to the toilet although your bowel is empty (tenesmus)
passing mucus or blood when you empty your bowels
slight soiling on your underwear or some leakage (incontinence), although this is rare.
Tell your cancer specialist, specialist nurse or radiographer about any bowel side effects you have.
Diarrhoea is the most common side effect and usually starts during or after the second week of radiotherapy. If you have diarrhoea, your specialist will prescribe anti-diarrhoea tablets such as Imodium® to reduce it.
Some people are advised to make changes to their diet during radiotherapy. This may involve eating a more bland diet and cutting down on fibre. Your specialist nurse or radiographer will tell you if this is appropriate for you. You’ll always be advised to drink plenty of fluids.
If you have tummy cramps, let your cancer specialist or nurse know. They can prescribe anti-spasmodic or muscle relaxant drugs to help with this. If you’re constipated, your doctor will usually prescribe a laxative and you’ll be given advice on diet.
Let your nurse or radiographer know if you have any soiling or leakage. They will give you advice on coping with this and looking after the skin.
Bowel side effects usually start to improve about two weeks after radiotherapy has finished. Sometimes, it may take a few months for the bowel to settle down.
What you can do
Drink at least 2-3 litres of fluid a day (to replace fluid lost through diarrhoea) and avoid drinks containing caffeine and alcohol.
Follow any dietary advice given by the hospital.
Take your anti-diarrhoea tablets or other medicines as prescribed by the hospital.
If side effects don’t get better, let the hospital know.
Avoid smoking, which stimulates the bowel and can make diarrhoea worse.
Your sex life
Protecting your partner
If you’ve had brachytherapy (radioactive seeds placed in the prostate gland), it’s advisable to use condoms during sex for the first few weeks after treatment. This is in case a radioactive seed moves from the prostate into the semen. However, it’s very rare for this to happen.
It’s fine to have sex during radiotherapy if you want to. However, sperm produced during and for some time after treatment may still be fertile but damaged. This could cause abnormalities in a child conceived soon after pelvic radiotherapy.
To prevent this, your doctors may recommend that you use contraception during and for six months or more after treatment.
Changes in ejaculation
Some men may have a sharp pain when they ejaculate. This is because radiotherapy can irritate the tube that runs through the penis from the bladder (the urethra – see diagram above). The pain should ease off a few weeks after treatment finishes.
After pelvic radiotherapy, the amount of semen you produce is reduced. This means that, when you ejaculate, you may notice that only a small amount of fluid comes out. Some men don’t produce any semen at all, and this is known as a dry ejaculation. Although you will still be able to orgasm (climax), some men find the sensation feels different from before.
Effects on fertility
Pelvic radiotherapy may make you unable to father children (infertile). Your doctor or specialist nurse can talk to you about the effect radiotherapy is likely to have on you.
For some men, it may be possible to have their sperm stored before the treatment starts (sperm banking). The sperm can then be used in the future. It’s important to talk to your doctor or nurse before your treatment starts. They can advise you about sperm storage.
After pelvic radiotherapy
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Most of the side effects of radiotherapy should gradually disappear once the treatment has finished. But it may take some time to recover. Looking after yourself by getting enough rest and gradually increasing your physical activity will help with your recovery.
Your cancer specialist or nurse may give you specific advice to help with your recovery. For example, you may be given information on when you can expect to go back to work, and on how to gradually build up your activities. If you smoke, it’s advisable to stop. There’s more information about recovery below.
After treatment, you’ll be seen at the hospital every few months for regular check-ups. Let your cancer specialist or nurse know if the side effects don’t improve, or if you develop new symptoms, even if it’s between appointments.
Share your experience
When treatment finishes, many people find it helps to share their thoughts, feelings and advice with others. This can be especially helpful for other men who may be about to start their treatment. Just hearing about how you’ve coped can be very helpful to someone in a similar situation. We can help you share your story.
Well-being and recovery
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After radiotherapy, you may want to think about ways you can help your recovery. We’ve included some ideas for improving your overall health. Some of these suggestions may help to reduce any ongoing side effects, the risk of developing certain late effects, other health problems and some cancers. These are things you may always have done or are already doing for yourself.
If you smoke, get help to stop
Smoking increases side effects during radiotherapy, so the best time to stop is before you start treatment. But it’s never too late to benefit from giving up smoking.
Smoking makes ongoing side effects worse, increases the risk of developing late effects and makes any late effects more severe. For example, smoking increases bladder symptoms and makes problems with diarrhoea worse. It can also contribute to erectile dysfunction and increase the risk of bone thinning (osteoporosis).
Giving up smoking is one of the healthiest decisions you can make. It can be hard to stop when you’re already feeling stressed, but there’s a lot of support available. If you want help and advice on how to stop, you can talk to your cancer specialist, specialist nurse or GP. You can also contact Smokefree.
Eating healthily will help you feel better and give you more energy. In general, a healthy diet includes five portions of fresh fruit and vegetables every day and not too much red or processed meat.
However, after pelvic radiotherapy some people may not be able to cope with as much fruit and fibre in their diet. If changes in your bowel habit are affecting what you can eat, let your cancer specialist or nurse know. They can refer you to a dietitian for advice.
Keep to a healthy weight
Being overweight is a risk factor for some cancers and other health conditions such as heart problems and diabetes. You may find our information about weight management after cancer treatment helpful.
Keep physically active
Keeping active will help build up your energy levels. It will also help you to keep to a healthy weight, strengthen your bones and protect your heart. Regular physical activity reduces stress and can help you sleep better.
Walking is a good way of staying physically active. You don’t need any special equipment and you can gradually build up how much you do. There are lots of other types of physical activity you can try too. There’s more information in our section on physical activity.
Stick to sensible drinking guidelines
Current guidelines recommend that men should drink no more than 21 units of alcohol a week and have some alcohol-free days every week. Alcohol can make any ongoing bladder and bowel side effects worse.
Possible long-term effects
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Late effects are side effects that don’t go away within six months (long-term), or new side effects that develop months or years later as a delayed response to treatment.
Many men who have pelvic radiotherapy don’t have late effects or, if they do, they are mild and don’t interfere with their daily lives. Newer ways of giving radiotherapy are designed to reduce the chance of developing late effects as much as possible.
The risk of getting late effects depends on different factors, including the type of cancer you had, the dose of radiotherapy and any other cancer treatments you’ve had. Your cancer specialist or nurse can tell you more about your risk.
If late effects do develop, they can often be treated effectively or managed to make them easier to deal with. Some late effects improve over time and may eventually go away on their own. The most common late effects after pelvic radiotherapy are changes to the bowel and bladder.
All these effects are discussed in our section about the long-term effects of pelvic radiotherapy.
It’s common to feel a range of emotions during and after cancer treatment, and it’s not unusual to have a low mood at first. But as you recover and get back to your everyday life, these feelings usually get easier to deal with. Talking to family and friends often helps. If things don’t improve or you feel anxious or depressed, let your doctor or nurse know so that they can arrange for more support for you.
Some people find meeting others in a similar situation helpful. There may be a local support group near you. Or you may like to join our online community, where you can get and give advice and support based on your own experiences.
This booklet has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been approved by our medical editor, Dr Tim Iveson, Macmillan Consultant Medical Oncologist.
With thanks to: Sue Davidson, Consultant Clinical Oncologist; Gillian Knowles, Nurse Consultant; Amen Sibtain, Consultant Clinical Oncologist; Andrew Stockdale, Consultant Clinical Oncologist; Mary Wells, Senior Lecturer in Cancer Nursing; members of the Pelvic Radiation Disease Association; and the people affected by cancer who reviewed this edition.
Faithfull S, Wells M. Supportive Care in Radiotherapy. Churchill Livingstone. 2003.
Halperin E, et al. Principles and Practice of Radiation Oncology. 5th edition. Lippincott Williams and Wilkins. 2008.
Harris R, et al. Radiotherapy Skin Care: A Survey of Practice in the UK. Radiography. 2012. 18 (1): 21–27.
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