Like all treatments for prostate cancer, radiotherapy can cause side effects. These will affect each man differently, and you might not get all the possible side effects. Sometimes bowel, urinary and sexual problems after radiotherapy treatment are called pelvic radiation disease.
Side effects happen when the healthy tissue near the prostate is damaged by radiotherapy. Most healthy cells recover so side effects may only last a few weeks or months. But some side effects can start months or years after treatment. These can sometimes become long-term problems. Before you start treatment, talk to your doctor, nurse or radiographer about the side effects. Knowing what to expect can help you deal with them.
If you have hormone therapy as well as radiotherapy, you may also get side effects from the hormone therapy. Read more about the side effects of hormone therapy and how you can manage them.
If you’re having radiotherapy as a second treatment, and you still have side effects from your first treatment, then radiotherapy can make those side effects worse or last longer. It may also cause other side effects. The most common side effects of radiotherapy are described here.
Short-term side effects of radiotherapy
Radiotherapy can irritate the lining of the bladder and the urethra, which is the tube men urinate (pee) and ejaculate through. This can cause urinary problems, such as:
- needing to urinate often, including at night
- a sudden urge to empty your bladder
- a burning feeling when you urinate
- difficulty urinating (urine retention)
- blood in your urine.
You might also leak urine (urinary incontinence) after radiotherapy, but this is rare. It may be more likely if you’ve previously had an operation called a transurethral resection of the prostate (TURP) for an enlarged prostate.
Urinary problems tend to start midway through your treatment and may begin to improve several weeks after treatment finishes. But this is different for everyone. Some men may continue to have side effects for longer, while others may not get any side effects at all or have side effects that improve more quickly. If you get any urinary problems, tell your doctor, nurse or radiographer. There are treatments to manage them, as well as things you can do to help yourself.
Your medical team may suggest pelvic floor muscle exercises that could help with your urinary problems. You can usually do these at home. Have a look at our interactive online guide for tips on managing urinary problems.
Your bowel and back passage are close to the prostate. Radiotherapy can irritate the lining of the bowel and rectum (called proctitis), which can cause bowel problems. Before you start radiotherapy, tell your doctor if you’ve had any bowel problems in the past as this could mean you’re more likely to get bowel problems again.
Symptoms vary from man to man, and some men only notice a slight change. Common bowel problems can include:
- passing more wind than usual, which may sometimes be wet
- loose or watery bowel movements (diarrhoea)
- needing to empty your bowels more often, or having to rush to the toilet
- leaking a clear, jelly-like mucus from your back passage
- feeling an urge to empty your bowels, but then not being able to
- a feeling that your bowels haven’t emptied properly
- pain in your abdomen (stomach area) or back passage
- bleeding from your back passage – this isn’t usually anything to worry about, but let your doctor, nurse or radiographer know if it happens
- leaking from your back passage (faecal incontinence) – this is very rare.
Bowel problems usually start during or shortly after your treatment and usually begin to settle down several weeks after finishing treatment. Again, this is different for everyone.
Some men may find that some of their side effects last longer, while others may not get any side effects at all, or have side effects that improve more quickly.
Tell your doctor, nurse or radiographer about any changes in your bowel habits. There are often things you can do to help yourself and simple treatments available.
If you have anal sex and are the receptive partner (bottom), then bowel problems after radiotherapy may affect your sex life. You may need to wait until any problems or sensitivity have settled before having anal sex. This will be different for everyone but may take about two months. Find out more about how side effects of prostate cancer treatment may affect your sex life if you have anal sex or you’re a gay or bisexual man.
Tiredness and fatigue
The effects of radiation on your body can leave you feeling very tired, especially towards the end of your treatment. Fatigue is extreme tiredness that can affect your everyday life. It can affect your energy levels, your motivation and your emotions – which can be hard to cope with.
This will usually start to improve several weeks after you finish radiotherapy, but for some men it could take up to a year. If you’re having hormone therapy as well as radiotherapy then this may also make you feel tired. You may feel very tired until you stop having hormone therapy.
There are things you can do to help manage fatigue. For example, planning your day and making the most of the energy you have. Try to stay active with some gentle exercise – start with a short and slow walk. Light exercise can lift your mood, and help you to feel more energised and awake. Always talk to someone in your medical team before starting a new exercise plan.
Some men continue to work during their treatment. If you’re dealing with fatigue, talk to your manager about different options, such as changing your working hours or working from home. It may be helpful to write down some things that you think could help. Share your ideas with your manager and work out a plan together. They might have some helpful suggestions as well.
If you’re worried about talking to your employer, remember that everyone has their own worries and health problems from time to time – most employers will be understanding and want to support you during your treatment. But if you think your employer is treating you unfairly, try talking to the human resource team at your workplace or contact Citizens Advice for more information.
Read more about ways to manage your fatigue or have a look at our interactive online guide. We also have a telephone support service for help managing fatigue.
One invaluable tip was to take a short rest each day when I got home after my treatment.
Problems with ejaculation
You may find ejaculation uncomfortable and notice that you produce less semen during and after treatment. You may also have a ‘dry orgasm’, where you feel the sensation of orgasm but don’t ejaculate. This may feel different to the orgasms you’re used to and some men find this difficult to come to terms with.
Skin irritation and hair loss
During treatment, the skin between your legs and near your back passage may become sore or look a bit like sunburn – but this is rare. Your radiographer will talk to you about how to look after your skin during treatment. Radiotherapy might also make some of your pubic hair fall out. But it usually grows back after treatment.
Long-term or late side effects of radiotherapy
Sometimes side effects can develop much later – several months, or even years, after finishing treatment. If this happens, then these side effects can last a long time.
Talk to your doctor or nurse about your own risk of long-term side effects. You might be more likely to get them if:
- you’re older
- you have diabetes
- you’re very overweight
- you’ve had bowel or prostate surgery in the past
- you’ve had bladder, bowel or erection problems in the past.
Researchers have been looking at whether smoking increases the chance of having long-term bowel and urinary problems after radiotherapy for prostate cancer. At the moment only a small number of studies have been done, so we need more research into this.
If you had urinary problems during treatment, you may be more likely to develop problems later on. These may be similar to the short-term side effects listed above.
Radiotherapy can cause the urethra to become narrow over time – this is called a stricture. This is more likely if you have brachytherapy combined with external beam radiotherapy. If this happens you will find it difficult to urinate. Symptoms can include:
- feeling that your abdomen (stomach area) is swollen
- feeling that you’re not emptying your bladder fully
- a weak flow when you urinate.
Speak to your doctor or nurse if you get any of these symptoms. Find out more about urinary symptoms. There are also lots of tips for managing urinary problems in our interactive online guide.
Although bowel problems often improve once treatment has finished, some men find that changes to their bowel habits last a lot longer.
Bowel problems can develop months or years after treatment and may be similar to the short-term side effects listed above. If you had bowel problems during treatment, you may be more likely to develop problems later on.
Try not to be embarrassed to tell your hospital doctor or your GP about any bowel problems. There are treatments that can help. Bowel problems can be common in older men, so it’s possible that they’re caused by something other than radiotherapy. Your hospital doctor or your GP can arrange tests to find out what’s causing the problems, or they may refer you to a bowel specialist.
If you have long-term bowel problems, you might be offered a camera test, such as a flexible sigmoidoscopy or a colonoscopy. This is where a narrow tube with a camera on the end is put into your back passage to check for any damage to the bowel.
Radiotherapy can cause problems getting or keeping an erection (erectile dysfunction). Other treatments for prostate cancer such as hormone therapy, other health problems, certain medicines, tiredness and fatigue, and depression or anxiety can all cause erection problems too.
Erectile dysfunction caused by radiotherapy often takes a while to appear and it can be up to two years before you notice any problems. Erection problems can also get worse over time.
There are some changes you can make to your lifestyle, as well as treatments that may help you manage erection problems or sometimes prevent them. For example, your doctor may prescribe regular medication to help with erectile dysfunction after your radiotherapy. These often work best if you start them soon after radiotherapy. Talk to your doctor, nurse or radiographer to find out more.
Find out more about erection problems, including what treatment is available and practical tips to help with your sex life. There are also lots of tips in our interactive online guide.
Radiotherapy can damage the cells that make semen and cause you to have a dry orgasm (where you don’t ejaculate). You may want to consider storing your sperm before you start radiotherapy, so that you can use it later for fertility treatment – if you want to. Ask your doctor, nurse or radiographer about sperm storage.
There is a very small chance that radiotherapy could affect any children you might conceive during treatment. If there is a chance of your partner getting pregnant, you may want to use contraception over the period you are having radiotherapy and for up to a year after. You can also ask your doctor, nurse or radiographer for advice. It is safe for you to have sex with your partner – you won’t pass on your cancer or any radiation.
If your lymph nodes are treated with radiotherapy, there is a small chance that fluid might build up in your tissues. This is called lymphoedema. It usually affects the legs, but it can affect other areas, including the penis or testicles. It can occur months or even years after treatment. Speak to your doctor or nurse if you start to get any unusual swelling. Read more about treatments that can help manage the symptoms of lymphoedema.
Hip and bone problems
Radiotherapy can damage the bone cells and the blood supply to the bones near the prostate. This can cause pain, and hip and bone problems later in life. Hormone therapy can also weaken your bones, so you might be slightly more likely to have hip and bone problems if you have both hormone therapy and radiotherapy.
Radiotherapy can damage the cells in the tissues surrounding the prostate. There is a very small chance that this could increase your risk of bladder or bowel cancer. It would take at least 5 to 10 years after having radiotherapy treatment for a second cancer to appear.