TREATMENT OPTIONS


 Nerve sparing radical prostatectomy


State-of-the-art external beam radiotherapy


Seed Brachytherapy


Patient Information For High Dose Rate Hdr Prostate Brachytherapy


Hormonal therapy


 Prostatic cryotherapy


Systemic chemotherapy


Radioactive intravenous Strontium


Access to state-of-the-art clinical trial


Patient Information for Radiotherapy


  1. Pain relief for metastatic bone disease


  1. Clinical Trials


Patient Information for Radiotherapy


BACKGROUND


X-rays have been used for many years to kill cancer cells within the prostate gland, and the curative benefit of radiotherapy is well known. Whether you have radiotherapy, surgery or hormonal therapy as a treatment for your prostate cancer is determined by a number of factors, which include the size of your prostate gland, your age, your general level of fitness, the nature of your prostate cancer and whether the prostate cancer has spread beyond the confines of the gland to other areas of your body.


PLANNING

Once a decision to treat you with radiotherapy has been made, you will need to attend a planning appointment. On this occasion (which usually takes approximately one hour) you will be escorted to undergo a CT scan of your pelvis. Prior to the CT scan, we prefer you to have a moderately full bladder and an empty rectum. Should your bladder be relatively empty and/or your rectum full, then side effects from radiotherapy may be more of a problem for you. The CT scan will be taken in order to accurately localise the size of your prostate gland and its position within your pelvis. Prior to the CT scan, you may be given oral contrast material to drink which will outline your bladder as part of the planning process.

Once the planning procedure has been completed, you will be provided with an appointment to commence your radiotherapy treatment which will usually be possible within a week or two following completion of the planning process. Any private CT scans used in the planning process will be returned to you as promptly as possible.

RADIOTHERAPY TREATMENT

Radiotherapy treatment is painless.

If it is our intention to cure your prostate cancer, you will be treated on a Monday to Friday basis for approximately 30-35 individual treatments over a 6-7 week period. You will be treated as an outpatient and there will be no need for you to be admitted to hospital.

Once your doctor has planned your course of radiotherapy, your treatment will be delivered by specially trained radiation therapists who will escort you into the radiotherapy suite at every occasion on which you attend. The radiation therapists will position you on the (hard) treatment couch and will switch on the radiotherapy machine from outside the room. The actual radiotherapy treatment takes approximately 3-4 minutes to deliver and you will be alone in the room during this time. However, you will be monitored on remote-controlled television from outside the room and you will be able to speak to the radiation therapists via a microphone in the room, if you need to do so. We anticipate that you will be in and out of the treatment room within 10-15 minutes per day. We aim to have you come and go from the Cancer Care Centre within 1 hour on each occasion of attendance (occasionally there will be some waiting around if specific members of the Cancer Care Team, eg doctor, nurse, nutritionist need to see you).

Your doctor will see you at least once every week to ascertain whether you are developing any side effects and to determine whether you have any questions about your treatment.

SIDE EFFECTS

Side effects during radiotherapy are common, but they are usually managed readily with medication. Apart from a general sense of tiredness, you will most likely develop radiation cystitis (urinary frequency, usually painless) and radiation proctitis (“diarrhoea”, some irritation around the anal region) after about 2 weeks on treatment. These side effects occur because the prostate gland is located quite close to both the bladder and rectum (bowel). The side effects are the result of an inflammatory reaction caused by the radiotherapy and they will wear off once the radiotherapy course has been completed.

THE TREATMENT OF SIDE EFFECTS

During your radiotherapy treatment, you will begin to experience the side effects noted above after the second week of treatment; these will slowly increase until the end of the radiotherapy course and they will then resolve over the subsequent 2-3 weeks. Side effects can be minimised by maintaining a moderate fluid intake and maintaining soft bowel actions during your course of treatment. Not everyone will develop inflammation and soreness of the anal area; however, if this does occur we routinely prescribe cortisone suppositories to reduce the inflammation (Scheriproct suppositories) and these should be inserted into the back passage twice or three times per day. Occasionally patients will also require a cortisone/local anaesthetic ointment to apply to the anal region (Scheriproct ointment). Should you develop any urinary burning or scalding, we will take a urine specimen to exclude a urinary tract infection prior to prescribing a urinary alkaliniser, eg Ural or Citrovescent.

FOLLOW-UP

Once your radiotherapy treatment has been completed, your doctor will make an appointment to see you 6-8 weeks later to be sure that your acute side effects have resolved. Thereafter, it will be important for you to return to see your urology specialist and your oncologist periodically. Your urologist will most likely repeat your PSA blood test at regular intervals. However, we do not advise repeating the PSA blood test within 6 weeks of completing your course of radiotherapy as the result may be artificially high.

Please contact your doctor or one of the nursing staff if you have any further questions in relation to your course of radiotherapy.

LATE SIDE EFFECTS

Impotence may be a late side-effect of radiotherapy in up to 30-50% of treated patients.

Bowel or urinary complications are very uncommon.