What Would Radiotherapy For Prostate Cancer Involve?

This is a treatment for:

Pre-treatment planning

Before you are treated, you will be asked to come for a radiotherapy planning session. At the initial appointment you will have a CT scan of the area to be treated. This CT scan allows the oncologist to accurately identify the structures that need treatment and where the beams will be aimed.

Planning is a very important part of radiotherapy and may take one or two visits. Before your scan, you will be asked to have a comfortably full bladder and have an empty bowel. This will help in targeting the treatment area more accurately. If you suffer from constipation, you need to tell your oncologist at the initial consultation.

Three reference dots (tattoos) are marked on the skin at the level of the prostate gland – one on the top and two on the sides. These are barely visible but will help the radiographers to position you accurately on a day to day basis for treatment.

The CT images are downloaded into the radiotherapy planning computer and your oncologist will localise the prostate gland, seminal vesicles, bladder, bowels and bones in order to target the cancer accurately and spare the normal tissues. A team of medical physicists will then produce a treatment plan which is authorised by your oncologist.

The treatment

External beam radiotherapy is given on an outpatient basis. The treatment is given daily, Monday to Friday, over six to eight weeks. Radiographers will position you carefully on a special bed and make sure you are comfortable. The radiation machine (linear accelerator) moves around the bed to deliver beams from different angles. During your treatment you will be left alone in the room but you are watched through cameras and will be able to talk to the radiographer. Radiotherapy is not painful but you have to lie still for a few minutes while the treatment is being given. Each daily treatment takes approximately 20 minutes, which includes time to position you on the treatment couch.

Possible short term side-effects

There are a number of side-effects which you may experience during treatment, which normally dissipate following the completion of your treatment. Most patients will continue with their normal daily activities during the treatment. You will be reviewed by your oncologist on regular basis during the treatment to assess any treat the side effects.

Radiotherapy may cause cystitis, making you want to pass urine more often and causing a burning sensation as you pass urine. This can be treated with medication. During radiotherapy, you may also feel more tired than usual. Regular gentle exercise, such as walking, can help to prevent and improve tiredness. It is also recommended to stay as hydrated as possible during the course of your treatment taking around six glasses of liquid during the course of the day.

Your treatment may cause irritation to the rectum, resulting in soreness and diarrhoea. Medicines can be prescribed to reduce these symptoms and you may be advised to change your diet during the course of your radiotherapy.

The radiographers will give you advice on skin care during radiotherapy. You may lose the pubic hair in the treatment area. This usually grows back but can be permanent.

Possible long-term side-effects of radiotherapy for prostate cancer

Most side-effects will settle down after your course of radiotherapy treatment has finished. However some side effects can become long term or permanent. These include long term bowel and urinary side effects such as chronic diarrhoea, rectal bleeding, cystitis, narrowing of the urethra and incontinence. With the new radiotherapy techniques, the risk of significant long-term side-effects is very small (less than five per cent presumably this statistic refers to the risks set out above, not erectile dysfunction which we set out below, but give a much higher risk stat). If these side effects occur, you will be referred to a specialist for treatment.

External beam radiotherapy can cause impotence or erectile dysfunction. The risk is higher in patients receiving hormonal treatment and those who suffer from diabetes or hypertension. There are special clinics called ED clinics for patients who become impotent after treatment for prostate cancer.

Image is of a radiotherapy plan for prostate cancer showing how the tumour will be targeted and normal tissue spared.