This fact sheet is for men who have been offered external beam radiotherapy to treat their prostate cancer.

Last updated: December 2018
To be reviewed: February 2021

References  

  • National Institute for Health and Care Excellence. Prostate Cancer: diagnosis and treatment. Full guideline 175. 2014.
  • Mottet N, Van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, et al. EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer. European Association of Urology; 2018.
  • Deville C, Both S, Hwang W-T, Tochner Z, Vapiwala N. Clinical toxicities and dosimetric parameters after whole-pelvis versus prostate-only intensity-modulated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):763–72.
  • James ND, Spears MR, Clarke NW, Dearnaley DP, Mason MD, Parker CC, et al. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer. JAMA Oncol. 2016 Mar;2(3):348–57.
  • Annede P, Seisen T, Klotz C, Mazeron R, Maroun P, Petit C, et al. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy. J Gastrointest Oncol. 2017 Feb;8(1):173–9.
  • Tromp D, Christie DRH. Acute and Late Bowel Toxicity in Radiotherapy Patients with Inflammatory Bowel Disease: A Systematic Review. Clin Oncol. 2015 Sep 1;27(9):536–41.
  • Schmidt-Hansen M, Hoskin P, Kirkbride P, Hasler E, Bromham N. Hormone and Radiotherapy versus Hormone or Radiotherapy Alone for Non-metastatic Prostate Cancer: A Systematic Review with Meta-analyses. Clin Oncol. 2014 Oct;26(10):e21–46.
  • National Institute for Health and Clinical Excellence. High dose rate brachytherapy in combination with external-beam radiotherapy for localised prostate cancer. Interventional procedure guidance 174. 2006.
  • Kulik A, Dąbkowski M. Prostate cancer radiotherapy. Contemp Oncol. 2011;15(5):317–22.
  • Kotecha R, Yamada Y, Pei X, Kollmeier MA, Cox B, Cohen GN, et al. Clinical outcomes of high-dose-rate brachytherapy and external beam radiotherapy in the management of clinically localized prostate cancer. Brachytherapy. 2013 Jan 1;12(1):44–9.
  • Freiberger C, Berneking V, Vogeli T-A, Kirschner-Hermanns R, Eble MJ, Pinkawa M. Quality of life up to 10 years after external beam radiotherapy and/or brachytherapy for prostate cancer. Brachytherapy. 2018;17:517–23.
  • Hoskin PJ, Rojas AM, Ostler PJ, Hughes R, Lowe GJ, Bryant L. Quality of Life after Radical Radiotherapy for Prostate Cancer: Longitudinal Study from a Randomised Trial of External Beam Radiotherapy Alone or in Combination with High Dose Rate Brachytherapy. Clin Oncol. 2013 May;25(5):321–7.
  • British Uro-oncology Group (BUG), British Association of Urological Surgeons (BAUS). Multi-disciplinary Team (MDT) Guidance for Managing Prostate Cancer. 2013.
  • Halkett GKB, Short M, Aoun S, Joseph D, Bydder S, Meng X, et al. What pelvic radiation disease symptoms are experienced by patients receiving external beam radiotherapy and a high-dose-rate brachytherapy boost for prostate cancer? J Contemp Brachytherapy. 2017 Oct;9(5):393–402.
  • Jarosek SL, Virnig BA, Chu H, Elliott SP. Propensity-weighted Long-term Risk of Urinary Adverse Events After Prostate Cancer Surgery, Radiation, or Both. Eur Urol. 2015 Feb;67(2):273–80.
  • Dess RT, Morgan TM, Nguyen PL, Mehra R, Sandler HM, Feng FY, et al. Adjuvant Versus Early Salvage Radiation Therapy Following Radical Prostatectomy for Men with Localized Prostate Cancer. Curr Urol Rep. 2017 Jul;18(7):55–55.
  • Fossati N, Karnes RJ, Colicchia M, Boorjian SA, Bossi A, Seisen T, et al. Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy. Eur Urol. 2018 Mar 1;73(3):436–44.
  • Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM, et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012 Dec 8;380(9858):2018–27.
  • James ND, Spears MR, Clarke NW, Dearnaley DP, Mason MD, Parker CC, et al. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial. JAMA Oncol. 2015 Nov 25;1.
  • Mason MD, Parulekar WR, Sydes MR, Brundage M, Kirkbride P, Gospodarowicz M, et al. Final Report of the Intergroup Randomized Study of Combined Androgen-Deprivation Therapy Plus Radiotherapy Versus Androgen-Deprivation Therapy Alone in Locally Advanced Prostate Cancer. J Clin Oncol. 2015 Jul 1;33(19):2143–50.
  • Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. The Lancet [Internet]. 2018 Oct [cited 2018 Oct 23]; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673618324863
  • Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016 Sep 14.
  • Lawrie TA, Green JT, Beresford M, Wedlake L, Burden S, Davidson SE, et al. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. In: The Cochrane Library [Internet]. John Wiley & Sons, Ltd; 2018 [cited 2018 Jul 19]. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012529.pub2/full
  • Institute of Physics and Engineering in Medicine, The Society of Radiographers, The Royal College of Radiologists. Radiotherapy Board - Intensity Modulated Radiotherapy (IMRT) in the UK: Current access and predictions of future access rates [Internet]. 2015 [cited 2017 Jul 10]. Available from: https://www.rcr.ac.uk/sites/default/files/imrt_in_the_uk_current_future_access_jul2015.pdf
  • Michalski JM, Moughan J, Purdy J, Bosch W, Bruner DW, Bahary J-P, et al. Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial. JAMA Oncol. 2018 Jun 1;4(6):e180039–e180039.
  • Chen LN, Suy S, Uhm S, Oermann EK, Ju AW, Chen V, et al. Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience. Radiat Oncol Lond Engl. 2013;8:58.
  • Bhattasali O, Chen LN, Woo J, Park J-W, Kim JS, Moures R, et al. Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer. Radiat Oncol Lond Engl. 2014 Feb 11;9:52.
  • Henderson DR, Tree AC, van As NJ. Stereotactic Body Radiotherapy for Prostate Cancer. Clin Oncol. 2015 May;27(5):270–9.
  • Koh D-H, Kim J-B, Kim H-W, Chang Y-S, Kim HJ. Clinical Outcomes of CyberKnife Radiotherapy in Prostate Cancer Patients: Short-term, Single-Center Experience. Korean J Urol. 2014 Mar;55(3):172–7.
  • NHS England. Clinical Commissioning Policy: The use of Stereotactic Ablative Radiotherapy (SABR) in the treatment of Prostate Cancer [Internet]. 2016 [cited 2018 Nov 7]. Available from: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/07/16031_FINAL.pdf
  • NHS England. Clinical Commissioning Policy: Proton Beam Therapy for Cancer of the Prostate [Internet]. 2016. Available from: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/07/16020_FINAL.pdf
  • Matei DV, Ferro M, Jereczek-Fossa BA, Renne G, Crisan N, Bottero D, et al. Salvage Radical Prostatectomy after External Beam Radiation Therapy: A Systematic Review of Current Approaches. Urol Int. 2015 Mar 4;94(4):373–82.
  • Wong JR, Gao Z, Merrick S, Wilson P, Uematsu M, Woo K, et al. Potential for Higher Treatment Failure in Obese Patients: Correlation of Elevated Body Mass Index and Increased Daily Prostate Deviations From the Radiation Beam Isocenters in an Analysis of 1,465 Computed Tomographic Images. Int J Radiat Oncol. 2009 Sep;75(1):49–55.
  • Smyth H. Does Obesity Impact Treatment Outcome for Prostate Cancer Patients Treated with Radiotherapy: The Weighted Debate. J Cancer Prev Curr Res [Internet]. 2014 Dec 20 [cited 2018 May 3];2(1). Available from: http://medcraveonline.com/JCPCR/JCPCR-02-00021.php
  • Doi H, Ishimaru F, Tanooka M, Inoue H, Odawara S, Takada Y, et al. Body mass index can affect gastrointestinal and genitourinary toxicity in patients with prostate cancer treated with external beam radiation therapy. Oncol Lett. 2014 Jan;7(1):209–14.
  • Koneru H, Cyr R, Feng LR, Bae E, Danner MT, Ayoob M, et al. The Impact of Obesity on Patient Reported Outcomes Following Stereotactic Body Radiation Therapy for Prostate Cancer. Cureus [Internet]. 2016 [cited 2018 May 8];8(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977219/
  • Wang LS, Murphy CT, Ruth K, Zaorsky NG, Smaldone MC, Sobczak ML, et al. Impact of obesity on outcomes after definitive dose-escalated intensity-modulated radiotherapy for localized prostate cancer. Cancer. 2015 Sep 1;121(17):3010–7.
  • National Institute for Health and Care Excellence. Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer. Interventional procedures guidance 590. 2017.
  • Moss RW. Do Antioxidants Interfere With Radiation Therapy for Cancer? Integr Cancer Ther. 2007 Sep 1;6(3):281–92.
  • Lawenda BD, Kelly KM, Ladas EJ, Sagar SM, Vickers A, Blumberg JB. Should Supplemental Antioxidant Administration Be Avoided During Chemotherapy and Radiation Therapy? JNCI J Natl Cancer Inst. 2008 May 27;100(11):773–83.
  • Tabassum A, Bristow RG, Venkateswaran V. Ingestion of selenium and other antioxidants during prostate cancer radiotherapy: A good thing? Cancer Treat Rev. 2010 May;36(3):230–4.
  • Yasueda A, Urushima H, Ito T. Efficacy and Interaction of Antioxidant Supplements as Adjuvant Therapy in Cancer Treatment. Integr Cancer Ther. 2016 Mar;15(1):17–39.
  • Margalit DN, Kasperzyk JL, Martin NE, Sesso HD, Gaziano JM, Ma J, et al. Beta-carotene Antioxidant Use During Radiation Therapy and Prostate Cancer Outcome in the Physicians’ Health Study. Int J Radiat Oncol. 2012 May;83(1):28–32.
  • Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D, et al. Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy. Int J Radiat Oncol. 2015 Aug;92(5):971–7.
  • Karsh LI, Gross ET, Pieczonka CM, Aliotta PJ, Skomra CJ, Ponsky LE, et al. Absorbable Hydrogel Spacer Use in Prostate Radiotherapy: A Comprehensive Review of Phase 3 Clinical Trial Published Data. Urology. 2018 May 1;115:39–44.
  • Hamstra DA, Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, et al. Continued Benefit to Rectal Separation for Prostate Radiation Therapy: Final Results of a Phase III Trial. Int J Radiat Oncol. 2017 Apr;97(5):976–85.
  • Pinkawa M, Berneking V, Schlenter M, Krenkel B, Eble MJ. Quality of Life After Radiation Therapy for Prostate Cancer With a Hydrogel Spacer: 5-Year Results. Int J Radiat Oncol. 2017 Oct 1;99(2):374–7.
  • Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016 Aug 1;17(8):1047–60.
  • Wilkins A, Mossop H, Syndikus I, Khoo V, Bloomfield D, Parker C, et al. Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2015 Dec;16(16):1605–16.
  • NHS England. Clinical Commissioning Policy: Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults) [Internet]. 2017. Available from: https://www.england.nhs.uk/wp-content/uploads/2017/10/clinical-policy-hypofractionated-external-beam-radiotherapy.pdf
  • Wilson JM, Dearnaley DP, Syndikus I, Khoo V, Birtle A, Bloomfield D, et al. The Efficacy and Safety of Conventional and Hypofractionated High-Dose Radiation Therapy for Prostate Cancer in an Elderly Population: A Subgroup Analysis of the CHHiP Trial. Int J Radiat Oncol • Biol • Phys. 2018 Apr 1;100(5):1179–89.
  • Catton CN, Lukka H, Gu C-S, Martin JM, Supiot S, Chung PWM, et al. Randomized Trial of a Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. J Clin Oncol. 2017 Jun 10;35(17):1884–90.
  • Andreyev HJN. GI Consequences of Cancer Treatment: A Clinical Perspective. Radiat Res. 2016 Mar 28;185(4):341–8.
  • Morris KA, Haboubi NY. Pelvic radiation therapy: Between delight and disaster. World J Gastrointest Surg. 2015 Nov 27;7(11):279–88.
  • Frazzoni L, La Marca M, Guido A, Morganti AG, Bazzoli F, Fuccio L. Pelvic radiation disease: Updates on treatment options. World J Clin Oncol. 2015 Dec 10;6(6):272–80.
  • Zapatero A, Guerrero A, Maldonado X, Álvarez A, González-San Segundo C, Cabeza Rodriguez MA, et al. Late Radiation and Cardiovascular Adverse Effects After Androgen Deprivation and High-Dose Radiation Therapy in Prostate Cancer: Results From the DART 01/05 Randomized Phase 3 Trial. Int J Radiat Oncol. 2016 Oct 1;96(2):341–8.
  • McCaughan E, McSorley O, Prue G, Parahoo K, Bunting B, Sullivan JO, et al. Quality of life in men receiving radiotherapy and neo-adjuvant androgen deprivation for prostate cancer: results from a prospective longitudinal study: Prostate cancer and QoL: a longitudinal study. J Adv Nurs. 2013 Jan;69(1):53–65.
  • Fridriksson JÖ, Folkvaljon Y, Nilsson P, Robinson D, Franck-Lissbrant I, Ehdaie B, et al. Long-term adverse effects after curative radiotherapy and radical prostatectomy: population-based nationwide register study. Scand J Urol. 2016 Sep 2;50(5):338–45.
  • Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, et al. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev. 2018 May 1;66:23–44.
  • Michalski JM, Yan Y, Watkins-Bruner D, Bosch WR, Winter K, Galvin JM, et al. Preliminary toxicity analysis of 3-dimensional conformal radiation therapy versus intensity modulated radiation therapy on the high-dose arm of the Radiation Therapy Oncology Group 0126 prostate cancer trial. Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):932–8.
  • Peach MS, Showalter TN, Ohri N. Systematic Review of the Relationship between Acute and Late Gastrointestinal Toxicity after Radiotherapy for Prostate Cancer. Prostate Cancer [Internet]. 2015 [cited 2018 Jun 12];2015. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677238/
  • Mohammed N, Kestin L, Ghilezan M, Krauss D, Vicini F, Brabbins D, et al. Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):204–12.
  • Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol. 2008;70(4):1124–9.
  • Schaake W, Wiegman EM, de Groot M, van der Laan HP, van der Schans CP, van den Bergh ACM, et al. The impact of gastrointestinal and genitourinary toxicity on health related quality of life among irradiated prostate cancer patients. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2014 Feb;110(2):284–90.
  • Ishiyama H, Hirayama T, Jhaveri P, Satoh T, Paulino AC, Xu B, et al. Is There an Increase in Genitourinary Toxicity in Patients Treated With Transurethral Resection of the Prostate and Radiotherapy?: A Systematic Review. Am J Clin Oncol. 2014 Jun;37(3):297–304.
  • Zerbib M, Zelefsky MJ, Higano CS, Carroll PR. Conventional Treatments of Localized Prostate Cancer. Urology. 2008;72(6):S25–35.
  • Parsons BA, Evans S, Wright MP. Prostate cancer and urinary incontinence. Maturitas. 2009;63(4):323–8.
  • Bauer RM, Gozzi C, Hübner W, Nitti VW, Novara G, Peterson A, et al. Contemporary Management of Postprostatectomy Incontinence. Eur Urol. 2011 Jun;59(6):985–96.
  • Berkey FJ. Managing the adverse effects of radiation therapy. Am Fam Physician. 2010 Aug 15;82(4):381–8, 394.
  • Mottet N, Peneau M, Mazeron J-J, Molinie V, Richaud P. Addition of radiotherapy to long-term androgen deprivation in locally advanced prostate cancer: an open randomised phase 3 trial. Eur Urol. 2012 Aug;62(2):213–9.
  • Thompson A, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, et al. Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis. J Clin Urol. 2014;7(1):25–35.
  • Shadad AK, Sullivan FJ, Martin JD, Egan LJ. Gastrointestinal radiation injury: Symptoms, risk factors and mechanisms. World J Gastroenterol WJG. 2013 Jan 14;19(2):185–98.
  • Andreyev HJN, Davidson SE, Gillespie C, Allum WH, Swarbrick E. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut. 2012;61:179–92.
  • THOR M, OLSSON CE, OH JH, PETERSEN SE, ALSADIUS D, BENTZEN L, et al. Relationships between dose to the gastro-intestinal tract and patient-reported symptom domains after radiotherapy for localized prostate cancer. Acta Oncol Stockh Swed. 2015;54(9):1326–34.
  • Alsadius D, Olsson C, Pettersson N, Tucker SL, Wilderäng U, Steineck G. Patient-reported gastrointestinal symptoms among long-term survivors after radiation therapy for prostate cancer. Radiother Oncol. 2014 Aug;112(2):237–43.
  • Ralph S, Richardson C. Developing UK guidance on how long men should abstain from receiving anal sex before, during, and after investigations and treatments for prostate cancer [MClin Res dissertation]. University of Manchester; 2018.
  • Luo H-C, Lei Y, Cheng H-H, Fu Z-C, Liao S-G, Feng J, et al. Long-term cancer-related fatigue outcomes in patients with locally advanced prostate cancer after intensity-modulated radiotherapy combined with hormonal therapy. Medicine (Baltimore) [Internet]. 2016 Jun 24 [cited 2018 Jul 19];95(25). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998328/
  • Langston B, Armes J, Levy A, Tidey E, Ream E. The prevalence and severity of fatigue in men with prostate cancer: a systematic review of the literature. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2013 Jun;21(6):1761–71.
  • Larkin D, Lopez V, Aromataris E. Managing cancer-related fatigue in men with prostate cancer: A systematic review of non-pharmacological interventions: Managing prostate cancer fatigue. Int J Nurs Pract. 2014 Oct;20(5):549–60.
  • Olsson CE, Alsadius D, Pettersson N, Tucker SL, Wilderäng U, Johansson K-A, et al. Patient-reported sexual toxicity after radiation therapy in long-term prostate cancer survivors. Br J Cancer. 2015 Sep 1;113(5):802–8.
  • Sullivan JF, Stember DS, Deveci S, Akin‐Olugbade Y, Mulhall JP. Ejaculation Profiles of Men Following Radiation Therapy for Prostate Cancer. J Sex Med. 2013 May;10(5):1410–6.
  • Schmid MP, Pötter R, Bombosch V, Sljivic S, Kirisits C, Dörr W, et al. Late gastrointestinal and urogenital side-effects after radiotherapy – Incidence and prevalence. Subgroup-analysis within the prospective Austrian–German phase II multicenter trial for localized prostate cancer. Radiother Oncol. 2012 Jul;104(1):114–8.
  • Kalakota K, Liauw SL. Toxicity After External Beam Radiotherapy for Prostate Cancer: An Analysis of Late Morbidity in Men With Diabetes Mellitus. Urology. 2013 Jun;81(6):1196–201.
  • Alashkham A, Paterson C, Hubbard S, Nabi G. What is the impact of diabetes mellitus on radiation induced acute proctitis after radical radiotherapy for adenocarcinoma prostate? A prospective longitudinal study. Clin Transl Radiat Oncol [Internet]. 2017 Mar 14 [cited 2018 Jul 20]; Available from: http://www.sciencedirect.com/science/article/pii/S2405630816300295
  • Alsadius D, Hedelin M, Johansson K-A, Pettersson N, Wilderäng U, Lundstedt D, et al. Tobacco smoking and long-lasting symptoms from the bowel and the anal-sphincter region after radiotherapy for prostate cancer. Radiother Oncol. 2011 Dec;101(3):495–501.
  • Steinberger E, Kollmeier M, McBride S, Novak C, Pei X, Zelefsky MJ. Cigarette smoking during external beam radiation therapy for prostate cancer is associated with an increased risk of prostate cancer-specific mortality and treatment-related toxicity. BJU Int. 2015 Oct;116(4):596–603.
  • Solanki AA, Liauw SL. Tobacco use and external beam radiation therapy for prostate cancer: Influence on biochemical control and late toxicity: Prostate Radiation Toxicity in Smokers. Cancer. 2013 Aug 1;119(15):2807–14.
  • Moltzahn F, Dal Pra A, Furrer M, Thalmann G, Spahn M. Urethral strictures after radiation therapy for prostate cancer. Investig Clin Urol. 2016 Sep;57(5):309–15.
  • Aluwini S, Pos F, Schimmel E, Krol S, van der Toorn PP, de Jager H, et al. Hypofractionated versus conventionally fractionated radiotherapy for patients with prostate cancer (HYPRO): late toxicity results from a randomised, non-inferiority, phase 3 trial. Lancet Oncol. 2016;17(4):464–74.
  • Olsson CE, Alsadius D, Pettersson N, Tucker SL, Wilderäng U, Johansson K-A, et al. Patient-reported sexual toxicity after radiation therapy in long-term prostate cancer survivors. Br J Cancer. 2015 Sep 1;113(5):802–8.
  • White ID, Wilson J, Aslet P, Baxter AB, Birtle A, Challacombe B, et al. Development of UK guidance on the management of erectile dysfunction resulting from radical radiotherapy and androgen deprivation therapy for prostate cancer. Int J Clin Pract. 2015 Jan;69(1):106–23.
  • Kyrdalen AE, Dahl AA, Hernes E, Cvancarova M, Foss\aa SD. Fatigue in hormone-naive prostate cancer patients treated with radical prostatectomy or definitive radiotherapy. Prostate Cancer Prostatic Dis. 2010;13(2):144–150.
  • Mohan R, Schellhammer PF. Treatment options for localized prostate cancer. Am Fam Physician. 2011;84(4):413–20.
  • Siglin J, Kubicek GJ, Leiby B, Valicenti RK. Time of Decline in Sexual Function After External Beam Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys. 2010 Jan;76(1):31–5.
  • Boehmer D, Badakhshi H, Kuschke W, Bohsung J, Budach V. Testicular dose in prostate cancer radiotherapy: impact on impairment of fertility and hormonal function. Strahlenther Onkol Organ Dtsch Röntgenges Al. 2005 Mar;181(3):179–84.
  • Royal College of Physicians of London, Royal College of Radiologists (Great Britain), Royal College of Obstetricians and Gynaecologists (Great Britain). The effects of cancer treatment on reproductive functions: guidance on management : report of a working party. Royal College of Physicians; 2007.
  • Rasmusson E, Gunnlaugsson A, Blom R, Björk-Eriksson T, Nilsson P, Ahlgen G, et al. Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer. Radiat Oncol. 2013 Nov 19;8(1):271.
  • Elliott SP, Jarosek SL, Alanee SR, Konety BR, Dusenbery KE, Virnig BA. Three-dimensional external beam radiotherapy for prostate cancer increases the risk of hip fracture. Cancer. 2011 Oct 1;117(19):4557–65.
  • Zelefsky MJ, Kollmeier MA, Gorshein E, Pei X, Torres M, McBride S, et al. Hip-related toxicity after prostate radiotherapy: Treatment related or coincidental? Radiother Oncol J Eur Soc Ther Radiol Oncol. 2016 Oct;121(1):109–12.
  • Davis EJ, Beebe-Dimmer JL, Yee CL, Cooney KA. Risk of second primary tumors in men diagnosed with prostate cancer: A population-based cohort study: Second Cancers in PC Survivors. Cancer. 2014 Sep 1;120(17):2735–41.
  • Murray L, Henry A, Hoskin P, Siebert F-A, Venselaar J, $author.lastName. Second primary cancers after radiation for prostate cancer: a review of data from planning studies. Radiat Oncol. 2013 Jul 8;8(1):172.
  • Moon K, Stukenborg GJ, Keim J, Theodorescu D. Cancer incidence after localized therapy for prostate cancer. Cancer. 2006 Sep 1;107(5):991–8.
  • Wallis CJD, Mahar AL, Choo R, Herschorn S, Kodama RT, Shah PS, et al. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. BMJ. 2016 Mar 2;i851.
  • Husson O, Mols F, Poll-Franse LV van de. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol. 2010 Sep 24;mdq413.
  • Trottier G, Boström PJ, Lawrentschuk N, Fleshner NE. Nutraceuticals and prostate cancer prevention: a current review. Nat Rev Urol. 2009 Dec 8;7(1):21–30.
  • Van Patten CL, de Boer JG, Tomlinson Guns ES. Diet and Dietary Supplement Intervention Trials for the Prevention of Prostate Cancer Recurrence: A Review of the Randomized Controlled Trial Evidence. J Urol. 2008 Dec;180(6):2314–22.
  • Pettersson A, Johansson B, Persson C, Berglund A, Turesson I. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: A randomized controlled trial in prostate cancer patients undergoing radiotherapy. Radiother Oncol. 2012 Jun;103(3):333–40.
  • Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev [Internet]. 2013 [cited 2014 Nov 18];(11). Available from: http://doi.wiley.com/10.1002/14651858.CD009896.pub2
  • Wedlake LJ, Shaw C, Whelan K, Andreyev HJN. Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther. 2013 Jun;37(11):1046–56.
  • Hechtman LM. Clinical Naturopathic Medicine [Internet]. Harcourt Publishers Group (Australia); 2014 [cited 2015 Jul 21]. 1610 p. Available from: http://www.bookdepository.com/Clinical-Naturopathic-Medicine-Leah-Hechtman/978072954192.
  • Tillisch K. Complementary and alternative medicine for functional gastrointestinal disorders. Gut. 2006 May 1;55(5):593–6.
  • Menichetti J, Villa S, Magnani T, Avuzzi B, Bosetti D, Marenghi C, et al. Lifestyle interventions to improve the quality of life of men with prostate cancer: A systematic review of randomized controlled trials. Crit Rev Oncol Hematol. 2016 Dec;108:13–22.
  • Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2016 Apr;69(4):693–703.
  • Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer. 2011 Nov 8;105:S52–73.
  • Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical Activity after Diagnosis and Risk of Prostate Cancer Progression: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor. Cancer Res. 2011 May 24;71(11):3889–95.
  • World Cancer Research Fund International. Continuous Update Project report: Diet, Nutrition, Physical Activity and Prostate Cancer [Internet]. 2014. Available from: www.wcrf.org/sites/default/files/Prostate-Cancer-2014-Report.pdf
  • Cao Y, Ma J. Body Mass Index, Prostate Cancer-Specific Mortality, and Biochemical Recurrence: a Systematic Review and Meta-analysis. Cancer Prev Res (Phila Pa). 2011 Jan 13;4(4):486–501.
  • Hu M-B, Xu H, Bai P-D, Jiang H-W, Ding Q. Obesity has multifaceted impact on biochemical recurrence of prostate cancer: a dose-response meta-analysis of 36,927 patients. Med Oncol Northwood Lond Engl. 2014 Feb;31(2):829.
  • Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol. 2014 Feb 1;32(4):335–46.
  • Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. J Pain Symptom Manage. 2012 Jan;43(1):96–110.

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