External beam radiotherapy uses high energy X-ray beams to treat prostate cancer. The X-ray beams are directed at the prostate gland from outside the body. The X-rays aim to destroy the cancer cells in the area they target. They are administered in small doses (fractions) over several days, usually Monday to Fridays.
Radiotherapy treats the whole prostate and a small area around it. The treatment is painless but it can cause side effects.
You may be able to have radiotherapy if your cancer is contained inside the prostate (localised prostate cancer). Radiotherapy may also be suitable for you if your cancer has spread to the area just outside the prostate (locally advanced prostate cancer).
Radiotherapy may also be used after surgery. This is usually if your Prostate Specific Antigen (PSA) level starts to rise or if tests suggest that not all the cancer was removed during surgery. Tests will be taken to confirm that the disease is still confined to the area where the prostate used to be before radiotherapy is offered.
Advantages of Radiotherapy
- It is an outpatient treatment and it is rare to require admission to hospital during the treatment.
- Many men are able to carry on with their normal day-to-day activities during treatment at least for part of the treatment regimen.
- Radiotherapy can be used to attempt to cure the disease even if you’re not fit or well enough for surgery.
- You will be in the treatment room for only around 20 minutes. You may have to spend longer drinking water and preparing for the treatment on the days you come to the hospital but you will not be present for longer than 2 hours.
Disadvantages of Radiotherapy
- You will need to go to hospital five days a week for 6-7 weeks. This might be difficult if you live far away from the hospital.
- Radiotherapy may cause side effects. These are outlined in detail below.
- It may be some time after radiotherapy is completed before you know whether the treatment has been successful.
- If you have radiotherapy as your first treatment and your cancer comes back or spreads, surgery might no longer be possible.
- Radiotherapy is usually given with hormonal therapy (see below)
Side Effects of Radiotherapy
The side effects of radiotherapy are divided into those that can occur during radiotherapy and those that can occur many months or years after radiotherapy. During radiotherapy you may notice:
- Tiredness (Fatigue)
- Discomfort in rectum or anus (back passage)
- Difficulty in passing water
- Skin irritation or breakdown (uncommon)
- Permanent and patchy pubic hair loss
- Frequency of urine, inflammation of and bleeding from the bladder (cystitis)
- A desire to pass motions and flatulence more frequently
Late effects of radiotherapy may take many months or years after treatment to happen. They include:
- Bleeding from the back passage
- Urgency of bowel movements
- Increased urinary frequency because the bladder is smaller or due to urethral (the tube through which you pass water) stricture
- Impotence (in about 60% of men)
- There is a risk of second malignancy with radiotherapy but this is very rare and would not usually occur until 15-20 years after treatment.
Radiotherapy is often administered with hormone treatments. The hormones are used to lower testosterone and reduce the prostate gland to make it as small as possible before the radiation treatment starts
Side Effects of Hormone Treatment
- Impotence (inability to have an erection)
- Loss of libido
- Hot flushes and sweats
- Breast soreness and swelling
- Tiredness and weakness
Side Effects of Hormones after Longer-Term Treatment
- Weight gain
- Mood swings
- Thinning of the bones
- Increased risk of heart disease and diabetes