Following your recent consultation, your doctor has recommended that your prostate cancer is treated using radiotherapy. This information aims to explain:

• How radiotherapy works in treating prostate cancer.
• The side effects of this treatment.
• Your follow up appointments after radiotherapy.

 
It is quite normal to feel anxious about your treatment, it may help to talk to someone about it. Please do not be afraid to ask, as we are here to help you. 
 
What is radiotherapy? 
 
Radiotherapy is the use of x-rays to treat your cancer and is given at the Northern Centre for Cancer Treatment (NCCT).  Radiotherapy works by destroying the cancer cells in the treated area, in your case, within the prostate gland.  
 
Radiotherapy is divided into a number of sessions called fractions. It is usually given each weekday for six to eight weeks. Using small fractions causes less damage to surrounding normal cells but can still result in some side effects. This leaflet will explain how to manage these.

How is radiotherapy planned? 
 
It is important to plan your radiotherapy specifically for you. You will need to attend three appointments before the radiotherapy is actually given. 

• The first appointment will be for the Mould Room. During radiotherapy you are asked to lie in the same position and stay as still as possible. To help you with this, a small mould or plastic straps are made to fit over your legs, which will help you to do this.
• The second appointment will be for a planning CT (computerised tomography) scan, which allows the oncologist to plan where the radiotherapy is to be directed.
• The third appointment is called a simulation session, which is a trial run of your treatment to ensure everything is set up correctly. You may receive your first radiotherapy treatment at this appointment.
   

How is radiotherapy given? 
 
Radiotherapy is painless and usually takes 10-15 minutes to deliver. There are private changing rooms within the treatment areas, as some items of clothing will need to be removed. The radiographers will advise you about this and will maintain your privacy at all times. They will take you to the treatment room and help you get into the correct position. You will then be left alone on the treatment couch. You will only be left alone for a few minutes while the treatment takes place and the radiographers will watch you on the TV monitors outside the room. You can attract their attention very easily if you require any assistance. 
 
The radiotherapy machine will rotate around your body to give the treatment in different directions. If you wish, you can have music playing to help you relax during your treatment. 
 
Whilst you are on treatment you will be seen every two weeks in the treatment review clinic by your oncologist, specialist nurse or radiographer. This is to see how you are doing during the radiotherapy and to discuss any questions or concerns you may have. If you experience any problems in between these review appointments, please inform one of your treatment radiographers.

What happens after treatment? 
 
Once you have finished your course of radiotherapy your doctor or nurse specialist will review you in the oncology outpatient’s clinic. Your first appointment will be approximately eight weeks after completing your radiotherapy, as we need to allow any side effects from the radiotherapy, time to settle down. You will then be seen every three to six months after that.
 
During this appointment your Prostate Specific Antigen (PSA) blood test will be taken to assess your response to treatment. Your prostate may also be examined but not necessarily at each visit. At the clinic you will have the opportunity to discuss your disease and the treatment you have received. You will also have the opportunity to discuss any concerns or worries you may have
following your treatment.

There are a number of side effects that may occur during your radiotherapy. Not everyone experiences them but if you do your specialist team will be able to advise you on how to treat them correctly. Listed below are some of the possible side effects most commonly experienced. If you are experiencing any other problems which are not listed please advise your specialist team who will be happy to discuss them with you.

Tiredness 
 
You may feel tired during your treatment and find that you need to go to bed earlier than you used to or have to take a short nap in the afternoon. This tiredness will resolve itself but it can take up to a couple of months. It may help to remain as active as you can during your radiotherapy but be aware of your limitations. 
 
Changes to your urinary system 
 
During your course of radiotherapy you may experience changes to your urinary symptoms, especially in the last few weeks and on completion of the radiotherapy. If you already have some problems with passing urine, unfortunately these may become worse. You may begin to experience some burning or stinging when you pass urine, sometimes called cystitis. You may feel the need to pass urine more frequently, especially at night. This could also coincide with a strong urgency to pass urine. Whilst having radiotherapy:

• Drink at least eight cups of fluid a day. Don’t be tempted to drink less.
• Avoid smoking and drinking alcohol or drinks containing caffeine – tea, coffee, coca-cola etc. They can all make any urinary problems worse. 

 
Altered bowel habits 
 
Changes in your bowel habits can occur during radiotherapy. If diarrhoea is a problem this is often very mild and changing to a low fibre diet can often help. A dietary advice leaflet is available from your treatment radiographers. Sometimes you may feel that you want to open your bowels frequently but only a small stool or no motion is passed. You may even pass mucus or a small amount of blood, this is called tenemus and you should talk to your specialist nurse or oncologist about this. Again, a low fibre diet can help and medication may be required.
 
Your bowel habits may continue to be disrupted for several weeks following radiotherapy but it should resolve. Please tell your oncologist or specialist nurse if it does not.

Skin reactions 
 
Some people may develop a slight skin reaction (reddening) within the area treated with radiotherapy. This is not very common and the following is advised:
 

• Wash treated skin gently everyday and pat dry. 
• Do not use creams, moisturisers or talcum powders on the area being treated. 
• Keep the treated skin away from direct sunlight or sunlamps. 

 
If a skin reaction occurs please inform your specialist team and they will be able to help you treat this. 
 
Impotence or sexual problems 
 
Most men will lose interest in the sexual aspect of their relationship and may be unable to get an erection. This is due to the hormone treatment but radiotherapy may also cause these problems. We understand that this may be a difficult problem to discuss. Your specialist nurse will be able to advise you on the different treatments available to help. 

This information is a guide to explain your treatment and is not intended to replace the information given to you by your consultant or specialist nurse. It contains a lot of information so if you have further questions regarding your treatment please contact your specialist nurse on the numbers below.
 
Sarah Rushbrooke and Karen Hertwick
Uro Oncology Nurse Practitioners
Northern Centre for Cancer Treatment
Newcastle General Hospital
 
Telephone:  (0191) 256 3585 (voicemail)
                      (0191) 233 6161 Bleep 1774
 
(Monday to Friday from 9am to 5pm)
 
Other useful sources of Information
 
Miss V Lockey
Information Centre Manager
Northern Centre for Cancer Treatment
Newcastle General Hospital
Newcastle Upon Tyne
NE4 6BE

Tel:  (0191) 256 3596
 
The Northern Cancer Network has an information website Northern Cancer Network
 
CancerBACUP  A registered charity providing information and support for cancer patients and their families

Telephone: 0808 800 1234