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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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Radiotherapy| for cancer of the prostate is usually given from an external machine (external beam radiotherapy). But for some men with early prostate cancer it can be given by inserting small radioactive seeds into the tumour (brachytherapy).
Radiotherapy| treats cancer by using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells.
External radiotherapy and brachytherapy both appear to be equally effective in curing prostate cancer. Your doctor may suggest that you have hormonal therapy| before or after your radiotherapy.
In early prostate cancer, the radiotherapy is given to the prostate gland. The aim is to destroy the cancer cells, while doing as little harm as possible to normal tissues in the surrounding area such as the bladder or back passage (rectum). This treatment is known as radical radiotherapy.
Radiotherapy is given in the hospital radiotherapy department, usually as daily sessions from Monday–Friday, with a rest at the weekend. For early prostate cancer, the course of treatment may last from 4–7 weeks.
Benefits: Radiotherapy may lead to a cure in early prostate cancer, but as with prostatectomy, the benefits in small, slow-growing cancers are uncertain. A complete course takes up to seven weeks. Giving hormonal therapy before and during the radiotherapy may improve the results.
Risks: For a small number of men, external beam radiotherapy to the prostate can cause long-term bowel problems, such as occasional bleeding and discomfort. Bowel motions may become looser and more frequent. Approximately 1 in 3 men will develop erection problems (this depends on your age and whether you are also being treated with hormonal therapy). Rarely, some men may have leakage or incontinence of urine. Radiotherapy to the prostate will also cause infertility.
Planning is a very important part of radiotherapy and may take one or two visits. The treatment has to be carefully planned to make sure that it’s as effective as possible. You’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. The treatment is planned by a cancer specialist (clinical oncologist).
Marks are usually drawn on your skin to help the radiographer (who gives you your treatment) position you accurately and show where the rays will be directed. These marks must stay in place throughout your treatment, and they may use permanent marks (like tattoos). These are tiny, and will only be done with your permission. You may feel a little uncomfortable while it’s being done.
At the beginning of each session of radiotherapy, the radiographer will position you carefully on the table, and make sure you are comfortable. During your treatment you will be left alone in the room but you can talk to the radiographer who will watch you from another room. Radiotherapy isn’t painful but you have to lie still for a few minutes during the treatment.
Conformal radiotherapy (CRT) or intensity modulated radiotherapy (IMRT) are usually used to treat early prostate cancer.
In conformal radiotherapy, a special attachment to the radiotherapy machine carefully shapes the radiation beams to match the shape of the prostate gland. Shaping the radiotherapy beams reduces the radiation received by the healthy cells in nearby organs such as the bladder and rectum. This reduces the side effects of radiotherapy treatment and may allow higher doses to be given, which could be more effective.
IMRT is a more complex type of conformal radiotherapy and allows the radiotherapist to vary the dose of radiation given to different parts of the tumour and surrounding tissue. It is not yet known whether IMRT is better than conformal radiotherapy.
Radiotherapy to the prostate can make it more difficult to have an erection. There are various treatments that can help. Radiotherapy may also reduce fertility and can make some men infertile. It may be possible to store sperm before treatment if you want to have children.
Radiotherapy to the prostate area may irritate the rectum, cause soreness around the anus and cause discomfort and diarrhoea. Your doctor can prescribe medicines to reduce this and you may be advised to make some changes to your diet.
Radiotherapy may also cause cystitis, which can make you want to pass urine more often or cause a burning feeling when you pass urine. Your doctor can prescribe medicines to reduce this. These effects usually disappear gradually a few weeks after the treatment has ended. If you have difficulty passing urine, it may be necessary to have a urinary catheter put in (this is a tube that is placed inside the bladder to help the urine to drain).
Radiotherapy can also cause general side effects such as tiredness|, which are mild for some men and more troublesome for others. The radiographer can advise you what to expect.
Try to balance rest with regular, gentle exercise, especially if you travel a long way for treatment each day.
The radiotherapy may make some of your pubic hair fall out|. When you have finished the course of treatment, the hair will grow back. However, it may be thinner or finer than before.
Most side effects of radiotherapy gradually disappear once the treatment has ended. However, others may continue for some months and some may even be permanent. If you have any problems during your treatment, let the radiotherapy staff know as they will be able to help you.
Radiotherapy doesn’t make you radioactive and it’s perfectly safe for you to be around other people, including children, throughout your treatment.
Although radiotherapy can get rid of the cancer cells completely for many men, in about 1 in 3 men (33%) the cancer cells may come back in the area of the prostate at some time after the treatment. In this situation, surgery can very occasionally remove the prostate gland. This is known as salvage surgery.
Radiotherapy to the prostate area can sometimes lead to long-term problems.
Radiotherapy for prostate cancer can cause an inability to have an erection (impotence) in about 3–5 in 10 of the men (30–50%) who have this treatment. Impotence may develop over a period of 2–5 years. We have information about ways of coping with erection problems|. This side effect of treatment can be difficult to deal with and can affect your sex life and your relationship with your partner.
You may find it helpful to read our information about sexuality and cancer|.
Many organisations| offer counselling for sexual or relationship problems.
Radiotherapy to the prostate can cause permanent infertility. Some men find this very difficult to cope with, whether they have children or not. If you want to father children after your treatment it may be possible to store sperm before treatment starts.
You may find it helpful to read our separate information about fertility|.
In a number of men, the bowel or bladder may be permanently affected by radiotherapy. The blood vessels in the bowel and bladder can become more fragile and this can make blood appear in the urine or when you pass bowel motions. This can take many months or years to occur. If you notice any bleeding, it’s important to let your doctor know so that tests can be carried out and appropriate treatment can be given.
Occasionally, bowel movements may be more urgent after radiotherapy and some people experience difficulty controlling the bowels (faecal incontinence). Let someone from your healthcare team know if this happens. Although it may feel embarrassing to talk about, they can give you practical advice.
Often, radiotherapy can help to improve problems with passing urine, but for some men it can lead to leakage of urine due to damage to the nerves that control the bladder muscles (urinary incontinence). This is unlikely unless you’ve had a TURP |(trans-urethral resection of prostate) or prostactectomy as well.
If this happens it’s important to discuss it with your doctor, who can arrange for you to see a specialist continence nurse. You may also find it helpful to contact the Bladder and Bowel Foundation|.
We have information about the long-term side effects of pelvic radiotherapy| in men.
This type of radiotherapy is available in some hospitals in the UK. It is also sometimes called internal radiotherapy, implant therapy or seed implantation. Brachytherapy can be carried out under a general anaesthetic or a spinal anaesthetic (epidural). Small radioactive metal ‘seeds’ are inserted into the tumour so that radiation is released slowly over a period of time.
The seeds are not removed, but the radiation gradually fades away over about six months. There is no risk of this treatment affecting other people.
Benefits: Same as for external beam therapy.
It’s a simpler procedure than external beam radiotherapy, as it usually only involves one planning and one treatment session. This is done under general anaesthetic during a stay in hospital of one or two days.
Risks: Side effects to the bladder, such as inflammation (cystitis) may be more severe than external beam radiotherapy, but bowel problems (diarrhoea) and impotence are less common. Scar tissue may cause gradual narrowing of the urethra which may need treatment.
Before the seeds are put into the prostate, a study of the prostate gland will be done (known as a volume study). This is to confirm the exact size and position of the prostate gland. For 24 hours before the volume study you’ll follow a special diet to make sure your bowel is empty. You’ll also be given an enema to empty your bowel, so that the ultrasound picture is as clear as possible. The volume study is done in the operating theatre and you’ll need to have an anaesthetic for a short time.
A trans-rectal ultrasound| is used to take pictures of the prostate. These provide a three-dimensional model which is then used to decide the number of seeds needed for treatment, and exactly where they should be put.
The implant procedure takes about one hour. An ultrasound probe is inserted into the rectum to show the prostate. Around 80–100 radioactive seeds are inserted through the skin between the prostate and anus and guided into the prostate gland.
A catheter is sometimes inserted into the bladder to drain urine. This is because the procedure may cause some swelling of the prostate, which can lead to blockage of the urethra (the tube that drains urine from the bladder). The catheter may be removed after a couple of hours or left in place overnight.
You’ll be given antibiotics after the implant to prevent infection. Most men go home the day after the implant, but some leave hospital as soon as they’ve recovered from the anaesthetic and are able to pass urine normally. After the implant it’s best to avoid heavy lifting or strenuous physical activity for 2–3 days.
All the radioactivity is absorbed within the prostate, so it’s completely safe for you to be around other people. However, women who are (or could be) pregnant and children should not stay very close to you for long periods of time. You shouldn’t let children sit on your lap, but you can hold or cuddle them for a few minutes each day and it’s safe for them to be in the same room.
The seeds stay permanently embedded in the prostate gland, but there is a tiny chance of a single seed being passed in the semen during sex. So it’s advisable to use a condom for the first few weeks after the implant. During this time the semen may be coloured black or brown – this is normal and is due to bleeding that may have occurred during the procedure. Double-wrap used condoms and dispose of them in a dustbin.
Brachytherapy causes similar side effects to external beam radiotherapy. It’s also common to feel mild soreness, and to have some bruising and discoloration between the legs for a few days after the procedure. Your doctor can prescribe painkillers to relieve this.
You may also notice some blood in the urine. This is quite normal but if it becomes severe or there are large clots present you should let your doctor know immediately. It’s important to drink plenty of water to help prevent blood clots and flush the bladder.
As with external radiotherapy, erection problems develop in 3–5 in 10 men (30–50%) some years after the treatment. Brachytherapy may cause infertility in some men|.
Brachytherapy may be less likely to affect the bowel than external beam radiotherapy, although the risk of urinary problems (such as narrowing of the urethra) is higher.
Up to 1 in 7 men may not be able to pass urine immediately after the procedure and may need to have a catheter inserted for a while. Some men may develop narrowing of the urethra some time later, which may cause problems with passing urine.
The risk of leakage of urine is about 1 in 100 (1%). Some men find that they have pain or discomfort when they pass urine, need to pass urine more often or have a weaker urine stream.
This is usually due to the radiation from the seeds in the prostate and improves over 3–12 months as the seeds lose some of their radioactivity. Drinking plenty of fluids and avoiding caffeine may help to reduce these effects.
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