Radiation treatment for prostate cancer long term effects

What does external beam radiotherapy involve?

You will have your treatment at a hospital radiotherapy department. Before you start your treatment, you’ll see a health professional who specialises in treating cancer with radiotherapy. These can include a specialist doctor known as a clinical oncologist, or a consultant therapeutic radiographer who has had additional training and specialises in prostate radiotherapy. You may also see the cancer nurse at the hospital. They’ll talk to you about your treatment options, including side effects, and ask for your consent for your radiotherapy treatment.

Before your radiotherapy treatment

Prostate radiotherapy preparation

You will need to prepare your bladder and bowel before the radiotherapy CT planning scan and before every radiotherapy treatment. The therapeutic radiographers get you to do this preparation because the prostate sits very close to your bladder, rectum and bowel. So the position of your prostate can change depending on the size of your bladder and rectum. If the size of the bladder and rectum change between your CT scan and your treatment sessions, it could mean the prostate is in a different position. This may affect the accuracy of the treatment and increase your risk of getting side effects.

Your therapeutic radiographer may ask you to have a comfortably full bladder and empty rectum so that the radiotherapy is aimed at your prostate, and that the surrounding areas get as little radiation as possible.

Before you have your CT scan and radiotherapy treatment, you will need to be well hydrated. You should drink about two litres (about four pints) of fluid throughout the day, a few days before your planning CT scan and throughout your treatment. This could be water or diluted squash. Limit fruit juice, fizzy drinks or drinks that contain alcohol or caffeine (like tea or coffee), as these can give you wind or irritate the bladder and make you urinate (pee) more often.

Some foods can make your rectum bigger or fill it up with gas. There are changes you can make to your diet to stop this.

• Reduce the fibre in your diet − but make sure you don’t cut it completely as it can make you constipated.
• Cut down food and drink that make you gassy. These include fizzy drinks, beans and pulses, spicy foods, and green leafy vegetables such as broccoli, cabbage and sprouts.

Every radiotherapy department does things slightly differently so use this as a general guide. Your therapeutic radiographer will go through the preparation with you before you have your CT planning scan, and your first radiotherapy treatment. If the preparation isn’t done properly, it can cause delays in your treatment. Speak to the radiotherapy team if you are unsure about any part of the preparation.

Radiotherapy planning session

You’ll have a CT scan two or three weeks before you start your treatment. Before you have your scan, the therapeutic radiographers will ask you to complete the radiotherapy preparation (see above). Some hospitals will give you a micro-enema, which is a laxative that helps to empty your rectum. You may be asked to empty your bladder before your scan and then drink some water. You will then wait between 30 and 45 minutes for your bladder to fill up. Your radiotherapy team will explain this to you at your appointment.

You'll be taken into the CT scanner and lie down on the scanner couch. You may also have an injection of contrast dye if you need treatment to your lymph nodes. The radiographer then takes a scan that shows the cancer and area around it. This scan is used to plan your treatment, so you won’t be given any results from the scan.

After the scan, your therapeutic radiographer will make three very small permanent marks (tattoos) on your skin. These will help to get you into the same position for each treatment session. It will feel like a pin prick, and the tattoos will be the size of a freckle.

 At some radiotherapy departments, you may have three or four gold seeds (fiducial markers) put inside your prostate. These are about the size of a grain of rice. An ultrasound probe is put into your back passage (rectum) to see your prostate. Hollow needles are then put into your prostate through your perineum (the area of skin between your testicles and back passage), and the seeds are passed through to your prostate. The seeds show up on X-ray images and help the therapeutic radiographer see the exact position of the prostate each day.

Some men find having scans and treatments stressful. If you are anxious about these, speak to your doctor or therapeutic radiographer. They will take the time to go through ways that will help you cope. They may be able to help by playing relaxing music in the room or talk to you during your scan or treatment to keep you distracted. Or you may be able to have medication to help you relax.

It might also help to wear clothing and shoes that are easy to take off and put on, such as slip-on shoes and trousers with an elastic waist, as you will have to do this for your CT planning scan and treatment sessions.

During your radiotherapy treatment

You will usually have one treatment (known as a session or fraction) at the hospital five days a week, with a rest over the weekend. You can go home after each treatment.

If you have localised prostate cancer, the course of radiotherapy usually involves 20 treatment sessions over four weeks. You might hear this called hypo-fractionated radiotherapy.

At some hospitals, you’ll have 37 sessions over seven or eight weeks instead. If you have 37 sessions, you’ll receive a slightly larger overall dose of radiotherapy – but the dose you receive at each session will be lower than if you have 20 sessions.

Studies have shown that having fewer treatment sessions over four weeks works just as well for men with localised prostate cancer as having more sessions over a longer time. The risk of side effects is also similar, and men usually find a shorter course of radiotherapy more convenient, as it involves fewer hospital visits.

If you have SABR, you will have as few as five sessions spread over one or two weeks.

You will have to follow the preparation before each treatment session. Your therapeutic radiographer will explain the treatment process and your radiotherapy preparation instructions. Once you are ready, your therapeutic radiographer will help you get into the exact same position as you were in at your planning scan. They’ll also use the permanent marks made on your body during the CT scan. This will help to make sure that the radiotherapy treatment targets the same area each time. You’ll have to keep very still while they get you in position. The therapeutic radiographers will then leave the room to give you the treatment. They can see you all the time and can come into the room if you need them.

The therapeutic radiographers will take a scan or X-rays to make sure the whole treatment area is covered, and that the radiotherapy targets the same area as in your planning scan. The treatment then starts, and the machine may move around your body. It doesn’t touch you and you won’t feel or see anything. The machine may make a buzzing sound as it works. You’ll need to keep very still, but the treatment only takes around 10 minutes, including the time it takes to get you into position.

You may also hear about image-guided radiotherapy (IGRT). This is used as part of all radiotherapy treatments. Taking images of the treatment area before each treatment allows your therapeutic radiographer to make small changes to the area that is treated, in case the prostate has moved slightly since your last treatment session. This makes sure the surrounding healthy tissue gets as little radiation as possible. IGRT also makes sure the whole treatment area is treated.

It’s safe for you to be around other people, including children and pregnant women, during your course of radiotherapy. The radiation doesn’t stay in your body, so you won’t give off any radiation.

Radiotherapy affects each person differently, but most people are able to carry on with their normal day-to-day activities. You may be fine to continue to work while having radiotherapy, or you may find it tiring and need time off work.

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