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Radiotherapy Treatment for Prostate Cancer

Introduction

You and your clinical oncologist have decided that a course of radiotherapy would be the appropriate way of treating your cancer.

When recommending radiotherapy, your doctor will have taken into account the risks and benefits of the treatment. Although there will be side effects, it is felt that the advantages for you would outweigh the disadvantages.

Your doctor will discuss the risks and benefits of having a course of radiotherapy and you will need to sign a consent form agreeing to have treatment. You will also be asked to confirm this consent verbally on the day of your planning scan and again on your first day of treatment.

The risks of receiving radiotherapy to the prostate are outlined on this page.

You may decide that you do not want to have radiotherapy – this is an option for you to consider. In this instance, you might want to talk again with your doctor and let them know what you have decided.

You can request a second opinion on your diagnosis or treatment at any time during your consultation or treatment process. Please speak to your clinical oncologist or GP for information on how to do this.

 

Patient Pathway

  1. Once you have consented (agreed) to radiotherapy, you will be referred for a CT planning scan and radiotherapy.
  2. Radiotherapy appointments are booked by the radiotherapy assistants team, they will call you and let you know the time of your CT planning scan and preparation appointments.

  3. Approximately 7-10 days before your CT planning scan you will have a preparation appointment by phone or at Northampton General Hospital, this will take approx. 30 minutes.

  4. You will attend The Oncology Centre at Northampton General Hospital for a planning CT scan. This appointment takes about one hour 30 minutes.
  5. Approximately two to three weeks later, you will attend the radiotherapy department for your first treatment.
  6. Treatment is usually given daily. A course of treatment is between four and seven and a half weeks.
  7. Your treatment is complete.

  8. You will be seen for a follow-up appointment at your original hospital either Kettering or Northampton.

 

What is radiotherapy?

Radiotherapy uses radiation (high energy x-rays) to treat cancer. The radiation only damages the cells within the treatment area, killing the cancer cells but allowing normal healthy cells to recover. Any side effects are usually isolated to the area being treated.

Treatment is given over a prescribed number of days and weeks so that only small doses (fractions) of radiation are given. Your clinical oncologist will prescribe the amount of radiation needed and will tell you how many treatments you will have and over how many weeks. Treatment is normally given on weekdays (Monday to Friday) with a break at the weekend.

It is important that you attend all of your treatment appointments.

Pacemakers/Implantable Cardioverter Defibrillator (ICD) – If you have a pacemaker or ICD, please tell your doctor as soon as possible. Although your device is not near the area being treated, you will need to have it checked before your treatment.

 

What happens before my radiotherapy?

Approximately 7-10 days before your scan you will have a phone or face to face appointment at Northampton General Hospital. This is where a member of the radiographer review staff will discuss the CT planning scan procedure and how to prepare for the scan and treatment.

Hydration – It is very important that you are well hydrated (drinking lots of fluid) and have a ‘comfortably full’ bladder for your CT scan and treatment. A comfortably full bladder means your bladder feels full but that you do not feel that you urgently need to empty it. Therefore we ask that you drink two litres( four pints) of fluid per day, especially water or other non-caffeinated drinks. You should reduce your intake of fizzy and alcoholic drinks.

A suggested way to keep hydrated is to drink a glass of water each one to one-and-a half hours during the daytime (more if the weather is hot or if you are exercising). Aim to drink a glass of water measuring about 150mls at these time intervals.

It is also important when you have your planning CT scan and treatment that you empty your bowels daily – being well hydrated will help you to do this but do not strain to open your bowels as this may cause problems.

If you are normally prone to flatulence, it is important to reduce the amount of gas you produce by avoiding food and drink that you know causes you be flatulent. These maybe different for different people.

Following these instructions will help to reduce the side effects of your treatment because less of your bladder and bowel will be in the radiation field. This will also make sure that your prostate is in the same position each day, ensuring that the treatment is accurate.

 

How do I prepare for my planning CT scan?

In addition to thinking about keeping yourself  well hydrated, we need you to practice filling your bladder and keeping it full. We suggest that you empty your bladder and then drink 350ml (approx two small glasses) of water. Ideally you should be able to hold your bladder for 45 minutes. Please do this every day from the day you consent to treatment.

 

What if I am unable to hold the water in my bladder?

If you are unable to hold your bladder with 350ml of fluid, try reducing the amount to 300ml and holding for 45 minutes. If you still can’t hold on, try decreasing the amount of fluid you drink until you find an amount of fluid that is comfortable for you to hold on to for the full 45 minutes. Aim to increase the volume of water daily until you are comfortable holding 350ml.

 

Who will look after me during my treatment?

 

A number of healthcare professionals will be involved in your treatment and care. Below is a list of all of the doctors, nurses, specialists and departments who will look after you while you are having radiotherapy.

Clinical oncologists are doctors who are trained in the use      of radiotherapy and chemotherapy. The consultant clinical oncologist will be in charge of your care. Clinical oncologists are supported by a team of specialist registrars, therapy radiographers, nurses and administrative staff.

Therapy radiographers are specifically trained to plan and deliver the radiotherapy. They provide  support  and  advice  on radiotherapy side effects and their management. The radiographers will have day-to-day responsibility for you while you are receiving radiotherapy.

Your advanced practice radiographers will provide support and advice on all aspects of your treatment including regular reviews during treatment.

Macmillan  Oncology  nurses  provide  support   and   advice on the side effects of radiotherapy and chemotherapy  and their management. Chemotherapy nurses will be involved in delivering chemotherapy treatment if necessary.

The Emergency Assessment Bay (contact details at the end of this page) will provide emergency medical advice or care for any side effects of treatment or problems relating to the cancer itself and are available 24 hours a day, 7 days a week.

 

Radiotherapy planning

 

What is a radiotherapy plan?

Your radiotherapy plan is the personalised design of your radiotherapy treatment. It is tailor-made for you and is based on the CT scan that you had. A team of doctors, radiographers and physicists will work together to decide where the treatment needs to be directed, avoiding as much healthy tissue as possible.

Following your initial outpatient appointment with the Oncologist, you will be telephoned by the radiotherapy assistant’s informing you of the time and date of your preparation and CT scan appointments.

Approximately 7-10 days before your CT scan you will have a preparation appointment to discuss how to prepare for the CT scan and treatment appointments and also for us get base lines for bladder and bowel function. This a good opportunity to ask questions regarding the radiotherapy treatment and any concerns you have. This maybe a telephone or face to face appointment.

 

Computerised tomography (CT) scan

A CT scanner is a special x-ray machine that produces a series of detailed pictures showing the structures of the pelvis.

 This scan is only for planning your treatment. The images are sent to a planning computer and used to reconstruct a three dimensional image of your pelvis. The clinical oncologist will then use this image to accurately plan your radiotherapy.

 

When you turn up for your scan

A member of the pre-treatment radiotherapy team will explain what is going to happen, and during this discussion, you will be asked to confirm your name, address and date of birth. You will be asked for this information before every procedure or treatment undertaken in the department.

We will then ask you to re-confirm consent to make sure you are certain that you would still like to go ahead with the proposed treatment.

You will then need to go to a toilet to try and empty your bladder and bowel, after that you will need to start drinking your 350mls of water. We have a water dispenser in the waiting area and it should take you no more than 10 minutes to drink the water, then we will wait 30 minutes to give your bladder time to fill.

You will need an empty bowel and a full bladder for the scan and also for all of your treatments. If however you cannot manage this, which can happen, the radiographers will give you advice and methods (such as senna or enemas) to help achieve this.

Please make sure you eat normally and drink plenty on the day of your scan and throughout your treatment appointments, and there is no harm in you being around other people after treatment, as you will not be radioactive in anyway.

 

During the CT scan

For the scan you will need to remove your trousers/shorts and shoes.

You will need to lie on the CT table on your back, with your hands on your chest. Your head, knees and ankles will be supported in specially-shaped rests. The radiographers will make make you as comfortable as possible so that you are able to lie very still. The radiographers will then scan your bladder with ultrasound to check your bladder volume.

Next a radiographer will make some pen marks on your pelvis and place a sticker on it to mark the area that needs to be scanned. This is done so that the mark shows up on your scan. The pen marks and stickers will be removed after the scan is completed. The CT table will be raised to go through the scanner and the radiographers will then leave the room.

The radiographers will be watching you at all times through the window. All you need to do is relax, breath normally and stay still. The radiographers will start the scan from outside the room. You will feel the bed slowly move in and out of the Scanner and hear the machine buzzing. The scan should only take a few minutes.

If your bladder or bowel is too full or too empty we may need  to get you off the bed to try and rectify this. Sometimes this can happen a couple of times to achieve the best scan to allow us to plan an optimal treatment.

 

After the CT scan

Once the scan is complete and satisfactory, the radiographers will come back into the room. They will take some measurements and make some very small permanent ink marks (tattoos) on your pelvis. These marks help to position you correctly for your future treatments.

The radiographers will assist you down from the scanning table and you may then get dressed and leave the department.

Before you leave, you will be given a parking permit for the hospital and a letter with your start date and time. You will be given a confirmed full list of appointments on your first day of radiotherapy treatment, approximately two to three weeks after your CT scan.

 

What will happen on my first day of treatment?

When you arrive for your appointment, you will be directed to the treatment waiting area.

One of the treatment radiographers will discuss your treatment with you and confirm consent, you will also be able to ask any questions that you may have before the treatment begins.

 

What will I need to do during my treatment?

You will need to have an empty bowel and a full bladder for your treatment. There are water dispensers in the waiting areas of the department if you need them. Having a full bladder and empty bowel helps to ensure the position of the prostate gland and helps to reduce the side effects of treatment.

Each day, please arrive in the department one hour before your appointment time to allow you to empty your bowel and bladder, then to drink water to fill your bladder for your appointment time. Or arrive with a comfortably full bladder and empty rectum ready for your appointment time.

You will be escorted into the room, where the radiographers will introduce themselves and ask you to identify yourself by telling them your name, first line of your address and your date of birth. After which, you will be asked to remove your trousers and shoes.

You will be asked to lie on the treatment table, which will be set up with the same equipment as when you had your CT scan. You should try to relax, lay still and breathe normally.

 

Radiotherapy treatment is given by a machine called a linear accelerator, often referred to as a Truebeam.

The lights will be dimmed so that the radiographers can see the room lasers that will help them to position you correctly. You will hear the machine move around you. It will come close to you but will not touch you. You will hear radiographers taking various measurements and feel the bed moving. Once you are in the right position, the radiographers will leave the room, and you will hear a beeping sound – this is the door safety interlock.

You will be alone in the room during your treatment but the radiographers will be watching you all the time on closed circuit television (CCTV). If you need assistance at any point, just wave a hand and the radiographers can immediately return    to the room. Digital x-ray images are taken regularly during your treatment to ensure that the treatment is being delivered accurately. There will be a short delay while these images are assessed and you may feel the bed move as the radiographers adjust its position from outside the room. Treatment will then be delivered and the machine will move around you to treat you from different angles.

 

During the treatment delivery you will not see or feel anything from the treatment, all you will notice is a buzzing noise.

This whole process will take approximately 15 minutes. Afterwards, the radiographers will return to the room, and help you down from the treatment table. The treatment table will be quite high up, so it is very important that you do not move or attempt to get off the table without assistance. The radiographers will tell you when it is safe to sit up and get off the table.

 

Treatment review

Throughout your treatment you will be seen or telephoned by members of the review team, to support you and help you to manage your side effects, or any other issues relating to your treatment. You will have separate appointments for this on your appointment list and we will also give you forms to fill out and hand back, where you can decline the review appointment if you feel you don’t want or need it.

 

What are the side effects of radiotherapy?

Receiving radiotherapy does have side effects. The most common side effects are listed below and are grouped into short-term and long-term effects. Your clinical oncologist or radiographer will have discussed these with you as part of your consent to treatment and they will also be on your copy of the consent form. You can ask someone in your treatment team at any point, if you would like more information about of these side effects.

While we cannot prevent side effects, we can help you to manage them. Side effects that occur during your radiotherapy are called early (or acute) side effects. They usually begin one to two weeks after your treatment starts. As your treatment progresses, these can become more severe and are usually at their worst up to two weeks after your radiotherapy treatment finishes. Then, they gradually start to improve and by three months after the end of your treatment, most will have resolved or at least improved considerably. Early side effects affect most patients, but the severity varies.

 

There are also side effects that occur months to years after the treatment has finished – these are called long-term side effects. You might experience long-term side effects – not everybody does. They may start during treatment and then gradually become worse, or they may develop slowly over a long period of time. Most improve slowly, but others may be permanent.

We use the most modern radiotherapy techniques available to reduce the side effects as much as possible, Some people will have few or very mild side effects and others will have more   of them and more severe. We will support you and help you to manage these side effects with advice, and medications when necessary. Also, you will be reviewed by the treatment review radiographers to assess your reactions to treatment.

 

Possible early side effects:

  • Painful urination: a burning sensation when passing urine or a change in flow rate.

  • Urinary frequency/urgency: the need to pass urine more often than usual, in the day/night and difficulty holding your urine.

  • Tiredness: a sense of fatigue and lack of energy may occur during radiotherapy but will slowly settle once treatment is complete.

  • Diarrhoea: stools may become looser and more frequent, and you may require medication to control this.

  • Sore rectum: soreness in the back passage, especially during bowel movement or passing blood or mucus.

 

Possible late side effects:

 

  • Impotence: inability to achieve or sustain an erection, with loss of sexual potency. This occurs in half of patients but may be helped with medication or mechanical devices in some instances.

  • Urethral narrowing: when the tube between the bladder and the penis narrows and results in a decrease in urinary flow, sometimes this may require catheterisation.

  • Inflammation of the rectum: occasionally some men pass softer stools more frequently and sometimes with some bleeding or mucus discharge this can be treated with medication.

 

Uncommon late side effects:

Every effort is made to minimise these effects and enhance the benefit from the treatment. All of the side effects below are very rare – your doctor will discuss them with you in detail.

  • Urethral narrowing: when the tube between the bladder and the penis narrows and results in a decrease in urinary flow, very rarely, you may require surgery to correct the problem.

  • Rectal incontinence can result from treatment and, very rarely, you may require surgery to correct the problem.

  • Late malignancy: there is an extremely small chance of developing another cancer near to the treatment area 10 years or more after treatment(1 in 1000 patients).

  • Weakening of pelvic bones due to radiotherapy.

 

Please remember:

If you are diabetic you will need to have appropriate drinks without sugar.

If you take regular pain medication or have any condition that may cause you pain or discomfort when laying flat on a hard surface. Ensure you bring your pain medications with you when on treatment or for the CT scan.

If you have or have had haemorrhoids in the past and they come back on treatment, please check with your staff before using ANY creams or ointments as they may cause problems if used during radiotherapy.

 

Managing the side effects of prostate radiotherapy

Some people have more side effects than others during radiotherapy. You may not experience all of the side effects listed below, but this does not mean the treatment is not working as well. It is important to remember that everyone reacts to treatment differently.

 

Change in bowel habit

You may find your bowel habit changes and you need to open your bowels more often.

If you develop diarrhoea inform the radiographers as they can give you practical advice on what to eat and what to avoid or arrange for a prescription for medication to help control your symptoms if it is required.

Try to drink at least two litres (four pints) of fluid a day. We recommend the following fluids:

  • water

  • squash

  • juice

  • herbal teas (caffeine-free).

 

Urinary frequency

A common side effect of radiotherapy can be the worsening   of any difficulties you may already have in passing urine. As treatment progresses you may find that you have to pass urine more frequently, that you experience increased urgency and that the flow may be reduced. These are normal side effects. However, if you experience stinging or burning when passing urine, please inform your radiographers, as these can be signs of a urinary infection. If there is an infection in your urine, we will prescribe a course of antibiotics for you.

If you are starting to experience urinary problems, try to reduce your intake of the following:

 

  • caffeinated drinks (coffee, tea, cola)

  • fizzy drinks

  • alcohol

  • high energy drinks, such as Redbull.

 

Try to drink regularly throughout the day (every hour if possible).

 

General tiredness (fatigue)

As you continue through your treatment, it is likely to make you feel extremely tired. This can be caused by several things:

 

  • The treatment itself – your body needs to repair itself, which uses up energy.

  • Any hormone therapy you are having – this can make you feel very tired.

  • Travelling – coming to and from the hospital for your appointments, as well as the change in your daily routine and interrupted nights can contribute to your fatigue.

 

This does not mean you have to put your normal life on hold. Give yourself time to relax – do not try to fight the tiredness. Try to eat a healthy, well balanced diet and drink plenty of fluids. Some studies have shown that taking a 20 minute walk each day can help improve feelings of fatigue.

 

General advice while having radiotherapy

 

Washing

It is important to keep the treatment area clean. Shower/bath using lukewarm water and use your usual soap or shower gel. Aqueous cream may be used as a soap substitute but not as a leave-on moisturiser. Use a soft towel to gently pat the skin dry – do not rub.

 

Moisturising

Moisturising in the treatment area will help your skin to cope better. You may continue to use your usual moisturiser or if  you need to buy one, we recommend one without the additive, sodium lauryl sulphate (SLS) or any metals. During treatment, apply the moisturiser sparingly twice a day or more often if your skin is very itchy.

 

Swimming

Reduce the number of times you swim in chlorinated water as this can have a drying effect on the skin. After swimming, shower to remove excess chlorine and discontinue swimming if the skin becomes sore.

Do not use any creams or ointments on your skin without checking with a radiographer first.

 

What happens when treatment ends?

 

Last week of radiotherapy

In the last week of treatment, you will speak to a treatment Review Radiographer to review your side effects and discuss how to manage them. The side effects are likely to peak at   the end of treatment and during the next two weeks and then normally start to improve.

After this review the Radiographer will write an end of treatment letter detailing your treatment, a copy will be sent to your GP, Clinical Nurse Specialist (CNS) and also to you for your own records.

 

Follow-up after treatment

Three to four months following the end of your treatment, you will be seen again or contacted by telephone by your team in the hospital where you were originally seen. This appointment is to check that you are recovering well and check your PSA via a blood test which will need to be done a week before this appointment.

In the long term, you will be followed-up by your oncology team or referring surgeon. This is to assess both your recovery and your response to treatment.

 

Commonly asked questions

 

Where can I get advice on financial support during treatment?

 Northamptonshire Macmillan Cancer Welfare Benefits Advice Service offers advice on financial and benefit information

 To book an appointment, please telephone 01604 235086 to speak to Raj or Laura or email rajinder.kainth@cencab.org.uk or l.richards@cencab.org.uk

 

When can I go on holiday?

 You can go on holiday as soon as you feel well enough.

 

When can I go back to work?

 Some patients continue to work throughout their radiotherapy treatment, while others may feel they need a few weeks break before returning. If you have had a long break from work it may be advisable to plan a phased return, where you work shorter hours at first.

 

How do I get further supplies of my medicines?

 After being prescribed medicines at the hospital, take the white copy of your prescription to Boots on hospital street, or take your advice to GP form to your GP who can continue to prescribe these for you.

 Anyone with a cancer diagnosis is entitled to free prescriptions. If you do not already have a medical exemption card, you can get an application form from your GP, the cancer centre or the oncology outpatient department. Please ask us if you need any further information.

 

Additional information

In order to improve treatments and services, audits are regularly carried out in the department. This can involve using patient notes. Any data collected will have all personal and identifying details removed to ensure patient confidentiality. However, if this is unacceptable to you, and you would prefer that your notes are not seen, please let your consultants know and your wishes will be respected. This will not affect your treatment.

Clinical trials are undertaken within the department, which you may be eligible to take part in. If necessary and appropriate, your doctor will discuss this with you. We are also a teaching hospital so students being fully supervised at all times may be involved in your treatment or in and around the department. Please inform us if you do not wish them to be in the room during your treatment.

 

Useful sources of information

 

Macmillan Cancer Support

 If you have any questions about cancer, need support, or just want to chat, call the free Macmillan Support Line. telephone: 0808 808 0000 (Monday to Friday, 9am to 8pm)

www.macmillan.org.uk

 

Prostate Cancer UK

Offering free confidential information and support.

Telephone: 0800 074 8383
Website: www.prostatecanceruk.org

 

Cancer Information Support Centre

Cancer Information Support Centre has a drop-in information area staffed by specialist nurses and offers complementary therapies, psychological support and benefits advice for patients and carers. The Cancer Information and Support Centre is located on the ground floor of the Oncology Centre area N.

 

Telephone: 01604 544211

 

NHS UK Website

Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health.

www.nhs.uk

 

Contact us

Telephone: 01604 (52) 3490

                   01604 (54) 5229

 

The Emergency Assessment Bay (EAB) Located in Talbot Butler Oncology Ward This line is manned 24 hours a day,7 days a week telephone: 01604 545851

Macmillan Urology Oncology Nurse Specialists’ Judith Fletcher, Alice Knight or Hollie Watts Telephone: 01604 (52) 3905

If unanswered please leave a message.

 

Your complaints, concerns and compliments

For advice, support , to raise a concern, make a complaint or pass on a compliment, contact our Patient Advice and Liaison Service (PALS).

Telephone: 01604 545784

An answer phone facility is available out of hours / during busy periods and we will respond to any messages as soon as we can. 

Email: PALS@ngh.nhs.uk

 Open Monday - Friday from 09:00 - 16:00, excluding bank holidays.

 

Other information

Northampton General Hospital operates a smoke-free policy. This means that smoking is not allowed anywhere on the Trust site, this includes all buildings, grounds and car parks.

Leaflets, information, advice and support on giving up smoking and on nicotine replacement therapy are available from the local Stop Smoking helpline on 0845 6013116, the free national helpline on 0300 123 1044, email: smokefree@nhft.nhs.uk and pharmacies.

Car parking at Northampton General Hospital is extremely limited and it is essential to arrive early, allowing ample time for parking. You may find it more convenient to be dropped off and collected.

This information can be provided in other languages and formats upon request including Braille, audio cassette and CD. Please contact (01604) 523442 or the Patient Advice & Liaison Service (PALS) on (01604) 545784, email: pals@ngh.nhs.uk.

 

 This information was taken from Northampton General Hospital leaflet NGV2342 (Oct 2020).

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