Like all treatments for prostate cancer, radiotherapy can cause side effects. These will affect each man differently, and you might not get all of the possible side effects. 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.
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 become long-term problems.
If you have hormone therapy as well as radiotherapy, you may also get side effects from the hormone therapy.
If you’ve already had treatment for prostate cancer such as surgery, and are experiencing side effects, then having radiotherapy afterwards can make those side effects worse or last longer. Radiotherapy may also cause other side effects.
The most common side effects of radiotherapy are described here.
Short-term side effects
Radiotherapy can irritate the lining of the bladder and the urethra (the tube men urinate and ejaculate through). Symptoms can include:
- 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 less common. This 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 mid way through your treatment and may begin to improve two to three weeks after treatment finishes. Some men continue to have side effects for several months. 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. Read more about urinary problems and how to manage them.
Your bowel and back passage (rectum) 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.
Symptoms vary from man to man, and some will notice a slight change rather than a problem. Common bowel problems can include:
- loose and watery bowel movements (diarrhoea)
- passing more wind than usual
- 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 something to be worried about, but let your doctor, nurse or radiographer know if it happens
- leaking from your back passage (faecal incontinence) – this is rare
Bowel problems usually start during or shortly after your treatment and may begin to settle down a few weeks after finishing treatment. Some men may find that some of their side effects last longer.
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, such as medicines to control diarrhoea.
If you’re gay, bisexual or a man who has sex with men, and are the receptive partner (‘bottom’) during anal sex, then bowel problems after radiotherapy may affect your sex life. You may need to wait until any problems or sensitivity has settled before having anal sex. Read more about side effects of prostate cancer treatment and how they may affect gay and bisexual men.
Tiredness and fatigue
The effects of radiation on your body can leave you feeling very tired, especially towards the end of your treatment. If you’re having hormone therapy as well as radiotherapy then this may also make you feel tired.
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.Fatigue can continue after the treatment has finished and may last several months.
There are things you can do to help manage fatigue. Read more about fatigue and how to manage it.
Problems with ejaculation
You may find ejaculation uncomfortable and notice that you produce less semen during and after treatment. You may 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.
Skin irritation and hair loss
During treatment, the skin between your legs and near your back passage may become sore – 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.
If you’re worried about any of these side effects, speak to your doctor, nurse or radiographer. You can also call our Specialist Nurses.
Long-term or later side effects
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’ve had bowel or prostate surgery in the past
- you’ve had bladder, bowel or erection problems in the past.
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 see 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.
Read more about urinary problems and how they can be managed.
Although bowel problems often improve once treatment has finished, some men will 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 (see 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 test called a flexible sigmoidoscopy.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. 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 lifestyle changes you can make as well as treatments that may help you manage erection problems or sometimes prevent them. These often work best if you start them soon after radiotherapy. Talk to your doctor, nurse or radiographer to find out more.
Read more about treating erection and other sexual problems, and practical tips to help with your sex life.
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, so you may wish to use contraception during and for at least a year after radiotherapy if there is a chance of your partner becoming pregnant. 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 slight 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 managing 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 treatment with radiotherapy for a second cancer to appear.
Smoking and side effects
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’re thinking of stopping smoking there’s lots of information and support available.