Radiotherapy for prostate cancer

You have external beam radiotherapy as an outpatient in the radiotherapy department. Radiotherapy is given using a machine called a linear accelerator. This is often called a LINAC.

You usually have radiotherapy as a series of short, daily treatments (fractions). Each treatment lasts around 10 minutes. But you will be in the radiotherapy department for longer. The treatments are given from Monday to Friday, with a rest at the weekend. Radiotherapy is not painful, but you need to lie still while you have it.

Depending on the type of radiotherapy, treatment fractions are usually given over 1 to 4 weeks. Your cancer doctor or radiographer will explain your treatment plan.

The radiotherapy does not make you radioactive. It is safe for you to be with other people during external radiotherapy, including children.

Your cancer doctor carefully plans your radiotherapy to make it as effective as possible, while keeping side effects to a minimum.

During the planning visit, you will have a CT scan. The scan is done to help your radiotherapy team plan the dose and area of your treatment. The hospital will send you information if you need to prepare for your scan.

Before your scan, you may need to have a special diet or take medicine to empty your bowel. You may also need to drink water to fill your bladder. At some hospitals, you may be asked to go to the toilet so your bladder is empty. Doing these things helps get very clear CT pictures for planning your treatment.

You may have a small amount of liquid passed into your rectum to empty your bowel. This is called an enema. It helps you empty your bowel fully when you go to the toilet. You can usually do this yourself. If you need help, speak to your radiotherapy team.

During the scan, you need to lie still in the same position you will be in for your radiotherapy.

A therapeutic radiographer will give you your treatment. They may make some permanent marks (tattoos) the size of a pinpoint on your skin. These are used to make sure you are in the correct position for your treatment. They also show where the beams will be directed. This is only done with your permission. It may be a little uncomfortable. If you are worried about this, talk to the radiographer.

Your doctor may talk to you about having some of the following or you may hear about these:

Side effects usually build up slowly after you start treatment. They may continue to get worse for a couple of weeks after treatment. But after this, most side effects improve gradually over the next few weeks.

Your radiotherapy team will talk to you about this. They will explain what to expect and give you advice on what you can do to manage side effects.

Always tell them about your side effects rather than trying to treat them yourself. There are usually things they can do to help. We list the common side effects here, but you may not get all of these. We have more detailed information about pelvic radiotherapy.

Radiotherapy can also cause inflammation of the bladder. This is called radiation cystitis. You may:

• feel you want to pass urine (pee) more often (frequency)
• have a burning feeling when you pee
• be unable to wait to empty your bladder (urgency)
• have difficulty in starting to pee.

Your cancer doctor or radiographer can prescribe medicines to help. Drinking 2 to 3 litres (3½ to 5½ pints) of fluids a day can help. Avoid drinks containing caffeine and alcohol. These side effects usually disappear slowly a few weeks after treatment has finished.

Some people may have difficulty passing urine, but this is rare. If you are having problems, you may need to have a tube put into the bladder to drain urine. This is called a urinary catheter.

Side effects can be worse if you already had bladder problems before starting radiotherapy. If you already had bladder problems before treatment, you may find them start to improve after radiotherapy finishes.

Radiotherapy to the prostate can irritate the lower bowel (rectum). You may get diarrhoea, wind and cramping pains in your tummy (abdomen). You may feel your bowel is not completely empty after going to the toilet. You may notice blood or mucus when you go to the toilet. It is important to tell your radiotherapy team about bowel side effects.

If you have diarrhoea, drink at least 2 to 3 litres (3½ to 5½ pints) of fluids a day. Avoid caffeine and alcohol. During treatment, your radiographer may advise you to make some changes to your diet, such as eating less fibre. These side effects usually improve by 6 weeks after finishing treatment.

Your cancer doctor, specialist nurse or pharmacist may give you anti-diarrhoea drugs to take at home. It is important to follow their advice about taking the drugs.

Symptoms can often be managed with medication and changes to your diet. If problems do not improve, you can ask to be referred to a late effects specialist or a bowel specialist – this may be a gastroenterologist or bowel surgeon. We have more information about bowel problems after pelvic radiotherapy.

Radiotherapy often makes people feel tired. Hormonal therapy can add to the tiredness. Tiredness (fatigue) may get worse as treatment goes on. There are things you can do to help:

• Get plenty of rest, but keep your daily routine if you feel able to.
• Do some regular exercise, such as going for a walk.
• Eat a healthy diet and drink plenty of fluids.
• Ask for help with everyday tasks, if you have friends or family members who can support you.

After treatment finishes, tiredness should improve. If it does not get better after a few weeks, tell your cancer doctor or specialist nurse.

Less commonly, the skin in the treated area may change colour. If you have white skin, it may become red. If you have black or brown skin, it may look darker.

The skin may also become dry or flaky, and feel itchy or tight. Sometimes the skin around the anus and scrotum becomes moist and sore. Your radiographer will give you advice. Your cancer doctor or radiographer can prescribe a cream or dressings and painkillers if you need them.

Your pubic hair may fall out. It usually starts to grow back a few weeks after you have finished treatment. It may be thinner than before.

Radiotherapy for prostate cancer can cause problems getting or keeping an erection. This is called erectile dysfunction (ED). ED may not happen straight away, but it can develop slowly over 2 to 5 years. About 30 to 45 out of 100 people (30% to 45%) who do not have any problems before radiotherapy develop ED after treatment.

You may have a higher risk of ED if:

• you are older
• you already had ED before treatment
• you have other medical problems that also cause ED, such as diabetes or heart disease
• you are taking hormonal therapy, which also causes ED and affects your desire to have sex (libido).

Ask your radiotherapy team about your risk of ED. If you develop ED, there are different treatments that can help.

After radiotherapy and brachytherapy, orgasms might feel different and you might ejaculate little or no semen. Hormonal therapy can also make your penis appear shorter in length. Your cancer team can talk to you about ways of preventing or helping this.

Radiotherapy to the prostate may cause infertility. This means you will no longer be able to to get someone pregnant. If you find this difficult to cope with or are worried, talk to your cancer doctor.

You may be able to store sperm before treatment starts.

Radiotherapy and a radical prostatectomy are both treatments that may cure early prostate cancer. They are equally effective in treating the cancer.

To choose the treatment that is best for you, it can help to look at the benefits and disadvantages of each one. You can then make your decision with your healthcare team.

• You do not need surgery or a general anaesthetic, which may have risks if you have other health conditions.
• You can usually keep doing most of your daily routine.
• Urinary problems may happen less often than after a prostatectomy.

• Depending on your treatment plan, you go to the radiotherapy department for treatments for 1 to 4 weeks.
• Bowel side effects may be worse in the short term than with a prostatectomy.
• It may be some time before you and your cancer doctor know if treatment has been successful.