This is high-energy X-ray beams targeted at the area being treated from outside the body. Radiotherapy permanently damages and kills cancer cells, but healthy cells can repair themselves and recover more easily.
As part of a first treatment for advanced prostate cancer
If you’ve just been diagnosed, you may be offered external beam radiotherapy to your prostate alongside other treatments. It won’t cure your cancer, but it can help some men live longer. It will only be an option if the cancer has only spread to bones in your pelvis or spine, or to lymph nodes. The treatment doesn’t appear to help men whose cancer has spread to bones away from the pelvis or spine, or to organs like the liver.
You'll have radiotherapy alongside hormone therapy, often with chemotherapy as well.
To treat symptoms
Advanced prostate cancer can cause symptoms in the areas it has spread to. External beam radiotherapy can help control these symptoms by slowing the growth of the cancer in those areas. You may hear this called palliative radiotherapy. For example, radiotherapy is effective at relieving pain caused by prostate cancer that has spread to the bones. Up to eight in every ten men (80 per cent) who have external beam radiotherapy for bone pain get some pain relief from it.
External beam radiotherapy can also treat prostate cancer that’s spread to the lymph nodes and can help with other symptoms of advanced prostate cancer, such as blood in the urine, bowel problems or kidney problems. It can also be used to treat an emergency condition called metastatic spinal cord compression (MSCC).
Other treatments that may help to manage symptoms include pain-relieving drugs and treatments for the cancer itself, such as hormone therapy or chemotherapy.
What are the advantages and disadvantages?
The advantages and disadvantages of radiotherapy depend on your general health, previous treatment and how far your cancer has spread. What may be important to one person might be less important to someone else. Talk to your doctor, radiographer or nurse about your own situation.
- External beam radiotherapy to the prostate can help some men live longer if their cancer hasn’t spread far from the prostate.
- It is painless, but you may find the treatment position uncomfortable if you have pain.
- Treatment sessions only last around 10 minutes, including the time it takes to get you into position. You don’t need to stay in hospital overnight.
- Most men who have radiotherapy for pain find it helps control their pain.
- You might be able to reduce the dose of any pain-relieving drugs you’re taking. This could be useful if they are causing side effects.
- Radiotherapy may control other symptoms, such as blood in the urine and bowel problems.
- If your pain comes back, you may be able to have more radiotherapy to the same area. This will depend on the dose you've already had and how long ago you had it.
- External beam radiotherapy to the prostate may not help men live longer if their prostate cancer has spread to distant bones or organs.
- If you’re having radiotherapy as a first treatment, you'll need to go to a specialist hospital for treatment daily or weekly for a few weeks. This might be difficult if you need to travel far.
- If you’re having external beam radiotherapy to the prostate, 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 find it inconvenient.
- For a few men, radiotherapy won’t help to control their pain.
- Radiotherapy can cause side effects. The risk of different side effects depends on the part of the body being treated.
- You might have slightly more pain during treatment, and for a few days afterwards. This should soon improve.
- The pain can come back after several months. If this happens, you might need further treatment with radiotherapy or other treatments.
Preparing for treatment
Before starting treatment you will usually have a planning session. This might involve having a CT (computerised tomography) scan. The planning session is to make sure the person treating you knows the exact position, size and shape of the area that needs treating.
At the end of your planning session, your radiographer will make a few very small permanent marks, like tiny tattoos, on your skin in the area to be treated. These help the radiographers put you in the right position for your treatment.
What does treatment involve?
You will have your treatment in the outpatient radiotherapy department at the hospital.
- If you’re having radiotherapy to the prostate, you may have radiotherapy five days a week for four weeks. Or you may have radiotherapy once a week for six weeks. You will probably need to have an empty bowel during your treatment. Some hospitals ask you to have a full bladder and others ask you to empty your bladder. This helps to make sure the radiotherapy beams target the exact same area during each treatment, and reduces the risk of side effects to your bowel or bladder. Your radiographer may give you an enema (liquid medicine) or a suppository (a pellet) to use either at home or at the hospital. These are put inside your back passage and help make sure your bowel is empty.
- If you’re having radiotherapy to treat symptoms, such as pain, you’ll have either a single dose directed at the area causing problems, or a series of smaller doses spread out over a week or more. You might have a dose every day, every few days or once a week. This type of radiotherapy uses a lower dose of radiation overall than radiotherapy for earlier stages of prostate cancer. The course of treatment is also often shorter.
At the beginning of each treatment, the radiographer will help you get into the right position on the treatment couch. They’ll use the marks made on your body as a guide.
The radiographer will then leave the room, but they’ll be able to see you at all times through cameras. The radiotherapy machine moves around your body and it will make a slight noise. It doesn’t touch you and you won’t feel anything – a bit like having an X-ray. You’ll need to lie very still, but the treatment only takes around 10 minutes, including the time it takes to get you into position. You should be able to go home after the treatment has finished.
It’s safe for you to be around other people, including children and pregnant women, while you’re having radiotherapy. The radiation doesn’t stay in your body so you won’t give off any radiation.
If you’re having radiotherapy to treat pain, it may take a week or more for your pain to improve, and it can take several weeks for the treatment to have its full effect. You may need to continue taking painkillers during this time. Pain relief usually lasts for an average of four to six months, but this can vary from person to person.
What are the side effects?
After external beam radiotherapy as a first treatment
Healthy tissue near the prostate may get damaged and this can cause side effects. These may only last a few weeks or months, but some side effects can last for longer or develop months or years after treatment. Possible side effects of radiotherapy to the prostate may include:
- urinary problems, such as needing to urinate often, a burning feeling when you urinate or difficulty urinating
- bowel problems, such as loose or watery bowel movements (diarrhoea), passing more wind than usual, needing to empty your bowel more often, feeling an urge to have a bowel movement but then not being able to go, a feeling that your bowels haven’t emptied properly, or pain in the stomach area (abdomen) or back passage
- blood in your urine or from your back passage (rectum)
- sore skin between your legs and near your back passage – this is rare
- erection or ejaculation problems, such as discomfort when you ejaculate, a reduced amount of semen or a ‘dry orgasm’, where you have the feeling of an orgasm but don’t ejaculate
- not being able to have children naturally – if you’re worried about this, your doctor, nurse or radiographer can talk to you about storing sperm for fertility treatment later
- a build-up of fluid in your legs (lymphoedema) – this affects a small number of men after radiotherapy to the lymph nodes.
After external beam radiotherapy to treat symptoms
There are usually only a few, if any, side effects from external beam radiotherapy when it’s used to treat symptoms of advanced prostate cancer. This is because you’ll only have a few doses of treatment. The risk of side effects is higher if you are having radiotherapy to several different areas or larger areas of your body, or if a higher total amount of radiotherapy is used.
The possible side effects will depend on the part of your body that’s treated and may include:
- red, dark or itchy skin in the treated area, similar to sunburn – if this happens, ask your radiographer for advice on how to look after your skin
- loose and watery bowel movements (diarrhoea) – this can be caused by radiotherapy to the pelvis or abdomen, but there are treatments that can help
- a slight increase in pain during the course of treatment or for a few days afterwards – it’s important to keep taking any pain-relieving drugs you’ve been given, and the pain should soon get better.