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External beam radiotherapy

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On this page we talk about how external beam radiotherapy can be used to try to get rid of localised prostate cancer (cancer that hasn’t spread outside the prostate) or locally advanced prostate cancer (cancer that has spread to the area just outside the prostate).

Radiotherapy can also be given to some men whose cancer has spread to other parts of the body (advanced prostate cancer). It may be used to help control the cancer or, more commonly, to relieve symptoms.

Watch Ally's story for one man's experience of external beam radiotherapy. 

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How does radiotherapy work?

Radiotherapy aims to destroy prostate cancer cells without causing too much damage to healthy cells. External beam radiotherapy is high-energy X-ray beams targeted at the prostate from outside the body. These X-ray beams damage the cancer cells and stop them from growing and spreading to other parts of the body (advanced prostate cancer). Radiotherapy permanently damages and kills the cancer cells, but healthy cells can repair themselves and recover more easily.

Radiotherapy treats the whole prostate. It aims to treat all the cancer cells, including any that have spread to the area just outside the prostate. The treatment itself is painless but it can cause side effects that may cause you problems.

You may have radiotherapy to a wider area, including the nearby lymph nodes, if there is a risk that the cancer has spread there. Lymph nodes are part of your immune system and are found throughout your body. The lymph nodes in your pelvic area are a common place for prostate cancer to spread to. If you do have radiotherapy to a wider area, you will be more likely to get side effects.

Who can have radiotherapy

External beam radiotherapy can be suitable for men with:

If your prostate cancer is localised or locally advanced, or if you have recurrent prostate cancer, radiotherapy will aim to get rid of the cancer completely.

If you have Crohn’s disease or ulcerative colitis, radiotherapy probably won’t be suitable for you. This is because it could make your bowel problems worse. Talk to your doctor or nurse about which treatments are suitable for you.

Radiotherapy for localised prostate cancer

If you’re having radiotherapy for localised prostate cancer you might also have hormone therapy for a few months before and during treatment. Hormone therapy can shrink the prostate and the cancer inside it, making the cancer easier to treat. You might have hormone therapy for a total of six months before, during or after external beam radiotherapy. If there is a risk of the cancer spreading outside your prostate, you may continue to have hormone therapy for up to three years after radiotherapy. Read more about hormone therapy.

If there’s a risk that your cancer could spread outside the prostate, you might also be offered a type of internal radiotherapy called high dose-rate (HDR) brachytherapy alongside your external beam radiotherapy. But this isn’t very common. HDR brachytherapy gives a high dose of radiation directly into your prostate through the perineum, which is the area between your testicles and back passage.

Having both types of radiotherapy together means you will have external beam radiotherapy to the prostate and the area just outside it, as well as an extra dose of radiotherapy to the prostate itself. This can help make treatment more effective, but might also mean you’re more likely to get side effects. Find out more about high dose-rate brachytherapy.

Adjuvant radiotherapy

Some men may also be offered radiotherapy very soon after having surgery if there’s a chance that their cancer might come back or wasn’t completely removed during the operation. This is called adjuvant radiotherapy. It may be offered to you if the level of PSA (prostate specific antigen) in your blood doesn’t drop below 0.1 ng/ml in the first six to eight weeks after your surgery. Or it may be offered if tests show that some cancer cells were left behind during surgery.

Adjuvant radiotherapy usually starts in the first six months after having surgery, but your doctor may suggest waiting until any urinary problems have improved.

Other treatment options

Other treatment options for men with localised prostate cancer include:

Radiotherapy for locally advanced prostate cancer

External beam radiotherapy combined with hormone therapy is the standard treatment for men with locally advanced prostate cancer. You may be offered hormone therapy for up to six months before radiotherapy. And you may continue to have hormone therapy during your radiotherapy, and for up to three years after it’s finished. Your doctor might also offer you high dose-rate brachytherapy alongside your radiotherapy and hormone therapy. Read more about locally advanced prostate cancer.

Other treatment options

Other treatment options for men with locally advanced prostate cancer include:

Radiotherapy after other treatments for prostate cancer

Radiotherapy can be an option if your cancer has come back after surgery (called salvage or second-line radiotherapy). It may also be possible after HIFU or cryotherapy. Read about treatment options if your cancer comes back.

Making a decision about which treatment to have is difficult, there’s pros and cons to them all. I felt a big sense of relief after I’d made my choice.

- A personal experience

 

If you have advanced prostate cancer

If your cancer has spread to other parts of the body (advanced or metastatic prostate cancer), external beam radiotherapy won’t be able to cure your cancer. But you may be offered radiotherapy to areas where the cancer has spread, to help with symptoms such as bone pain. And new research has found that giving radiotherapy to the prostate itself can help some men who’ve just been diagnosed with advanced prostate cancer to live longer. Read more about radiotherapy for advanced prostate cancer.

  • Unsure about your diagnosis and treatment options?  

    If you have any questions, ask your doctor, nurse or radiographer. They can talk you through your test results and your treatment options. Make sure you have all the information you need. You can also speak to our Specialist Nurses.

What types of radiotherapy are there?

There are two common types of external beam radiotherapy:

  • intensity-modulated radiotherapy (IMRT)
  • 3-dimensional conformal radiotherapy (3D-CRT).

You may also hear about image guided radiotherapy (IGRT). This is part of all radiotherapy treatments. Taking images of the prostate before each treatment allows your radiographer to make small changes to the area that is going to be 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. It also makes sure the whole prostate is treated.

Intensity-modulated radiotherapy (IMRT)

This is the most common type of external beam radiotherapy in the UK. A computer uses the scans from your radiotherapy planning session to map the location, size and shape of your prostate. The radiotherapy machine gives beams of radiation that match the shape of the prostate as closely as possible. This helps to avoid damaging the healthy tissue around it, reducing the risk of side effects.

The strength of the radiation can be controlled so that different areas get a different dose. This means a higher dose of radiation can be given to the prostate without causing too much damage to surrounding tissue.

3D conformal radiotherapy (3D-CRT)

As with IMRT, the radiation beams are mapped to the size, shape and position of the prostate. But the strength of the radiation can’t be controlled in 3D-CRT, so all areas are treated with the same dose.

IMRT is now the standard type of external beam radiotherapy for prostate cancer in most hospitals, but some still use 3D-CRT. They are both effective ways of treating prostate cancer. Ask your doctor or radiographer which type of radiotherapy you’re being offered.

Other types of radiotherapy

Stereotactic radiotherapy

Stereotactic radiotherapy, also known as stereotactic ablative radiotherapy (SABR), is another type of radiotherapy. It is a very precise treatment which means the cancer itself gets a high dose of radiation, while the surrounding tissue gets less. It may also mean you need fewer treatment sessions. Cyberknife® is an example of stereotactic radiotherapy. It delivers many thin beams of low-dose radiation from different angles that all target the cancer. But it’s newer than other types of radiotherapy, so we don’t yet know how well it works compared to other treatments for prostate cancer.

At the moment, stereotactic radiotherapy for prostate cancer is only available as part of a clinical trial or through private healthcare. Speak to your doctor, nurse or radiographer for more information.

Proton beam therapy

You might have heard of a type of radiotherapy called proton beam therapy. This uses beams of tiny particles called protons to target and kill cancer cells. It’s mainly used to treat children and adults with very rare types of cancer. Proton beam therapy isn’t used to treat prostate cancer in the UK. This is because standard radiotherapy works just as well as, or better than proton beam therapy for prostate cancer.

  • Clinical trials  

    A clinical trial is a type of medical research that aims to find new and improved ways of preventing, diagnosing, treating and managing illnesses. There are clinical trials looking into the best ways of using radiotherapy to treat prostate cancer.

    Read more about clinical trials. Or to find out about taking part in a clinical trial, ask your doctor or nurse, or speak to our Specialist Nurses.

What are the advantages and disadvantages of external beam radiotherapy?

What may be important for one person might not be so important for someone else. If you’re offered external beam radiotherapy, speak to your doctor, nurse or radiographer before deciding whether to have it. They can tell you about any other treatment options and help you decide if radiotherapy is right for you.

Advantages of external beam radiotherapy 

  • If your cancer is localised or locally advanced, radiotherapy will aim to get rid of the cancer completely.
  • Many men can carry on with many of their normal activities while having treatment, including going to work and driving.
  • Radiotherapy can be an option even if you’re not fit or well enough for surgery.
  • Radiotherapy is painless (but you might find the treatment position slightly uncomfortable).
  • The treatment itself only lasts around 10 minutes, including the time it takes to get you into position. But you’ll probably need to be at the hospital for up to an hour each day to prepare for your treatment. You don’t need to stay in hospital overnight.

Disadvantages of external beam radiotherapy

  • You will need to go to a specialist hospital for treatment five days a week for a few weeks. This might be difficult if you have to travel far.
  • Your bowel may need to be empty during each treatment session. You may be given medicine to help empty your bowel each day. This can take a while to work, and some men may find this inconvenient.
  • Radiotherapy can cause side effects such as bowel, urinary and erection problems, as well as tiredness and fatigue. But there are usually treatments and ways to help manage these.
  • It may be some time before you know whether the treatment has worked.
  • If you have radiotherapy as your first treatment and your cancer comes back or spreads, it might not be possible to have surgery afterwards. This is because the radiotherapy may have damaged the prostate and surrounding tissues, making it harder to remove the prostate and increasing the risk of side effects.

I was able to continue working throughout my treatment, although I got tired quickly. I had some side effects but nothing I couldn’t cope with.

- A personal experience

  • Having radiotherapy if you’re very overweight  

    Each treatment session may take longer than usual if you’re very overweight. This is because it may be harder to get you into the right position on the treatment bed. The machine may also need to be on for longer, so that the right dose of radiation reaches the prostate. Some studies suggest that side effects of radiotherapy can also be worse for men who are very overweight. Read more about having a healthy lifestyle.

What does external beam radiotherapy involve?

You will have your treatment at a hospital radiotherapy department. You’ll see a specialist doctor who treats cancer with radiotherapy, known as a clinical oncologist. You may also see a specialist nurse and a specialist radiographer. They’ll talk to you about your treatment plan and ways to manage any side effects.

Before your radiotherapy treatment

Radiotherapy planning session

A week or two before your treatment, you’ll have a planning session. This is to make sure the radiographers know the exact position, size and shape of your prostate. It will help them make sure the radiotherapy is aimed at your prostate and that the surrounding areas get as little radiation as possible.

  • You’ll have a CT (computerised tomography) scan, and possibly an MRI (magnetic resonance imaging) scan.
  • Your radiographer will make three very small permanent marks (tiny tattoos) on your skin. This will help to get you into the right position when you go for each treatment.
  • At some radiotherapy departments, you may have three or four gold seeds, called 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) and the seeds are passed through the probe using a hollow needle. The seeds show up on X-ray images and help the radiographer see the exact position of the prostate each day.
  • Your doctor or radiographer may suggest using a rectal spacer to reduce the amount of radiation that reaches your back passage and possibly help lower your risk of bowel problems after treatment.
  • Your radiographer will let you know how full or empty your bladder and bowel should be during treatment. This helps to make sure your radiographer treats the right area equally each time. They’ll explain how much to drink, and how to make sure your bowel is empty.

During your radiotherapy treatment

You will have one treatment (known as a 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.

Before each treatment session you may be given an enema (liquid medicine) or a suppository (a pellet). These are put inside your back passage and will help make sure your bowel is completely empty. Then your radiographer will help you get into the exact same position you were in at your planning session. They’ll use the marks made on your body as a guide and may also take a scan. This will help to make sure that the radiotherapy treatment targets the same area each time.

The treatment then starts and the machine moves around your body. It doesn’t touch you and you won’t feel anything. 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.

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 man differently, but most men 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.

  • Anti-oxidants and radiotherapy  

    Talk to your doctor or nurse if you take anti-oxidant supplements. Some research suggests that anti-oxidants might protect the cancer cells and stop radiotherapy working as well. But the evidence for this isn’t very strong and we need more research to understand the possible risks.

  • Using a rectal spacer to protect your back passage  

    Your doctor or radiographer may suggest using a rectal spacer to help protect the inside of your back passage from radiation damage. The spacer is placed between your prostate and your back passage. This means that less radiation reaches your back passage, which may help to lower your risk of bowel problems during or after your treatment. If your hospital doesn’t use rectal spacers, you may be able to have one through private healthcare, or as part of a clinical trial. Ask your doctor, nurse or radiographer for more information about rectal spacers and other ways to manage bowel problems.

What happens after radiotherapy?

After you’ve finished your radiotherapy, you will have regular check-ups to monitor your progress. This is often called follow-up. The aim is to:

  • check how your cancer has responded to treatment
  • help you deal with any side effects of treatment
  • give you a chance to raise any concerns or ask any questions.

Your follow-up appointments will usually start two or three months after treatment. You will then have appointments every three to six months. After three years, you may have

follow-up appointments less often. Each hospital will do things slightly differently, so ask your doctor or nurse for more details about how often you will have follow-up appointments.

PSA test

The PSA test is a blood test that measures the amount of a protein called prostate specific antigen (PSA) in your blood. You will usually have a PSA test a week or two before each follow-up appointment, so the results are available at your check-up. This can often be done at your GP surgery. PSA tests are a very effective way of checking how well your treatment has worked.

After treatment, your PSA level should start to drop. Your PSA level won’t fall to zero as your healthy prostate cells will continue to produce some PSA. But it could fall to about 1 ng/ml, although every man is different and your medical team will monitor your PSA level closely.

How quickly your PSA level drops, and how low it falls, will depend on whether you had hormone therapy at the same time as radiotherapy. Try not to worry if it doesn’t fall below 1 ng/ml. If you had radiotherapy on its own, it may take 18 months to two years for your PSA level to fall to its lowest level (nadir).

Your PSA level may actually rise after your treatment is finished, and then fall again. This is called ‘PSA bounce’. It could happen up to three years after treatment. It is normal, and doesn’t mean your cancer has come back.

If your PSA level rises by 2 ng/ml or more above its lowest level, or if it rises for three or four PSA tests in a row, this could be a sign that your cancer has come back. Your doctor will continue to check your PSA level and will talk to you about further tests and treatment options if you need them.

Treatment options after radiotherapy

If your cancer does come back, there are further treatments available. You may be offered hormone therapy to control your cancer, or you may be offered another treatment that aims to get rid of your cancer.

Treatments that aim to get rid of cancer that has come back are called salvage treatments. After radiotherapy these may include surgery, high-intensity focused ultrasound (HIFU), or cryotherapy. There is no standard or best treatment after radiotherapy – your treatment options will depend on you and your cancer. For example, surgery can be difficult after radiotherapy because radiotherapy changes the prostate tissue and makes it harder for a surgeon to remove the prostate.

You may be more likely to get side effects if you have a second treatment. More research is also needed to look at how well treatments after radiotherapy work in the long term. Read more about what happens if your prostate cancer comes back.

Looking after yourself after radiotherapy

At some hospitals, you may not have many follow-up appointments after your treatment and be encouraged to take greater control of your own health and wellbeing. You might hear this called supported self-management.

Instead of having regular appointments at the hospital, you may talk to your doctor or nurse over the telephone. You’ll still have regular PSA blood tests to check how your cancer has responded to treatment (see below). But your GP may give you the results over the phone or in a letter. Some men prefer this type of follow-up, as it means you can avoid going to hospital appointments when you’re feeling well and don’t have any concerns.

Your doctor or nurse will give you information about the possible side effects of your treatment and any symptoms to look out for, as well as details of who to call if you notice any changes.

You, or your doctor or nurse, can arrange an appointment at any point if you have any questions or concerns.

What are the side effects of external beam radiotherapy?

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

Urinary problems

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.

Bowel 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.

- A personal experience

 

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.

Urinary problems

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.

Bowel problems

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.

Erection problems

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.

Having children

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.

Lymphoedema

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.

Other cancers

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.

  • Screening for bowel cancer  

    If you’re invited to take part in the NHS bowel screening programme soon after having radiotherapy, the test may pick up some blood in your bowel movements, even if you can’t see any blood yourself. Your doctor, nurse or radiographer may suggest that you delay your NHS bowel screening test for a few months if you’ve recently had radiotherapy. This will help to make sure that you don’t get incorrect results.

    It’s quite common to have a tiny amount of blood in your bowel movements while having radiotherapy, and shouldn’t be anything to worry about. But if you’re having radiotherapy and you do notice blood you should always let your doctor know.

  • Travelling with urinary or bowel problems  

    Not all men get urinary or bowel problems after radiotherapy. But if you do, it shouldn’t stop you from travelling. The following tips may help you plan ahead and feel more prepared for your trip.

    • Try to book an aisle seat close to toilets and find out where the nearest public toilets are.
    • If you use pads, make sure you pack enough for your trip.
    • Keep a spare change of clothes and an empty plastic bag with you to store wet clothes.
    • Wear dark trousers if you’re worried about leaks.
    • Carry some hand gel and a pack of wet wipes or tissues when travelling – supermarkets sell these in small sizes that are easy to carry.
    • Use our Urgent toilet card to help you get to a toilet quickly.

    Read more about travelling when you have prostate cancer.

Questions to ask your doctor, nurse or radiographer

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What type of radiotherapy will I have?
  • How many sessions will I need?
  • What other treatment options do I have?
  • What are the possible side effects and how long will they last?
  • What treatments are available to manage the possible side effects from radiotherapy?
  • Will I have hormone therapy and will this carry on after radiotherapy?
  • How and when will I know if radiotherapy has worked?
  • If the radiotherapy doesn’t work, which other treatments can I have?
  • Who should I contact if I have any questions?
  • What support is there to help manage long-term side effects?

References

Updated: December 2018 | Due for Review: February 2021

  • List of 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.
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