Radiotherapy to the prostate 

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Your oncologist has recommended a course of radiotherapy to your prostate. This information sheet provides a brief introduction to radiotherapy and explains the common side effects you may experience. This does not mean you will definitely get them. It is also possible you may experience a side effect not mentioned here.

Your oncologist may also have recommended a course of hormone injections. The side effects of these are explained on a separate information sheet. Please arrange to continue these injections at your GP's surgery. It should been have made clear to you how long they should be continued. Often this is until the start of the radiotherapy usually 3 to 6 months from the first visit to the Oncologist.

Your first appointment  at the radiotherapy centre will be in the  CT scanner. Report to the reception desk, show them your card, and they will direct you. The purpose of this visit is to plan and arrange the radiotherapy so you may not have a formal consultation with the doctor at this stage. Of course any urgent issues will be addressed but others should be saved for the regular consultations you will have during treatment. It is often difficult to judge exactly how long each patient will take - it is possible you may have to wait a long time.

The planning CT takes  CT  pictures to enable the oncologist to decide the exact area of your pelvis which needs treatment. While very accurate measurements are taken, you will have to lie on a fairly hard couch which may be slightly uncomfortable. A small tattoo about the size of a pin head is made on your body - giving a permanent record of the measurements. You will be asked to open your bowels before the CT scan but try to have the bladder full. Too much faces in the rectum can lead to potential inaccuracies whilst a full bladder reduces the dose of radiotherapy to the bladder.

In some radiotherapy departments they will advise you to take a low residue diet and a gentle laxative such as senna to ensure the rectum is empty (see diet sheet for radiotherapy to the prostate). 

A second CT is required about 7-14 days after the first to verify what the doctor has drawn before treatment starts.

The treatment machine  lis a large machine located down a long L-shaped corrider. Although the radiographers are not in the room while you are treated, you are being watched at all times on a camera. If you feel any distress, the machine can be turned off - the radiographers will be at your side within seconds. There is also a two way intercom. Treatment usually lasts only 1 to 2 minutes. You usually do not have any unusual sensations when the machine is turned on. After treatment you will not be radioactive and you will not lose the hair on your head.

Additional information   the MacMillan booklets "Understanding radiotherapy" and "Understanding cancer of the Prostate" .   A video called "Radiotherapy & chemotherapy" is also available from some information centres or     

The side effects of radiotherapy can be broadly split into two categories. Firstly, the early or acute side effects. These come on during or shortly after treatment, and depend on the size and area of the body being treated. Secondly, late side effects are those which can develop months or even years after the end of radiotherapy. These are the ones your oncologist worries about most. 

 Acute side effects

Your appetite may be affected. If so try to eat several small meals rather than three large meals a day. Drink lots of fluid - try to double your normal fluid intake. If you are worried about diet ask your radiographer to refer you to a dietician.

You may get tired during your radiotherapy course, this doesn't limit your ability to drive but adequate rest is important.

You will probably experience discomfort on opening your bowels (Proctitis). Very occasionally this may be associated with some blood and mucous in the stools.  This comes on in the later half of your Radiotherapy .  Steroid suppositories are sometimes prescribed for a short period of time if this is troublesome.  

Initially the prostate swells with radiotherapy usually causing some worsening of the prostate outflow symptoms - reduced stream, getting up at night to pass water, a feeling of incomplete emptying - some tablets which relax the muscles at the entrance of the bladder can help in this situation - e.g flomax. In addition and area of your bladder is also in the treatment area, o  may experience a feeling of wanting to pass urine more often with some burning (cystitis). It is still possible to develop a urinary tract infection so drink plenty of fluids and report any burning feeling, on passing urine, to your doctor. Some patient get relief from drinking cranberry juice.

Recent advances in radiotherapy technique have considerably reduced the dose and hence risk of damage to your bowel. Nevertheless, occasionally your bowels may become loose later in the treatment, possibly causing diarrhoea. If this happens, cut down your intake of fruit, vegetables and fibre and try to increase your intake of eggs, milk and other dairy products. Report any diarrhoea to the doctor or radiographer as it may be necessary for you to have tablets. Take these until the diarrhoea improves and then reduce them. Your bowels should have returned to normal 2-3 weeks after treatment. You can then gradually re-introduce fibre into your diet until you are back on a normal diet.

You may experience a feeling of nausea or sickness may occur during treatment. Report any nausea or vomiting to your doctor as your symptoms can be relieved with anti-sickness tablets. For larger treatment areas you will be given an anti-sickness tablet to prevent nausea.

The skin in the treated area may become red and sore, especially in the skin creases. You can wash by means of a shower during your treatment but it is not advisable to sit and soak in a hot bath and avoid rubbing with a towel or scratching. If any soreness develops report this to the radiographer who will give you advice.

 Late side effects

Your acute side-effects usually resolve within 1 month. Very rarely, they continue for several months and can permanent in a few:

Some patients will notice that they have to pass urine more frequently than before radiotherapy. The majority of patients do not find these symptoms troublesome even if they persist indefinitely.

Your ability to get an erection (potency) may be affected especially if impaired before treatment or hormone injections were given for > 6 months - ask your doctor about Viagra or similar drugs.

Around 10% continue to have  rectal discomfort  some urgency and mucous discharge in the long term. About 5% e may also notice occasional blood in the stools. Very rarely people may experience more serious side effects (< 0.5%). These include narrowing of the bowel or bladder which may require an operation to correct the damage.

Lifestyle and self help strategies: Research has shown that men who exercised regularly, had a normal weight and did not smoke had a lower risk of side effects. 

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