Feedback
We appreciate and encourage feedback. If you need advice or
are concerned about any aspect of care or treatment please
speak to a member of staff or contact the Patient Advice and
Liaison Service (PALS):
Freephone (City Hospital Campus): 0800 052 1195
Freephone (QMC Campus): 0800 183 0204
From a mobile or abroad: 0115 924 9924 ext 65412 or 62301
Minicom: 0800 183 0204
E-mail: [email protected]
Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614,
Nottingham NG7 1BR
www.nuh.nhs.uk
Radiotherapy to the pelvis
for cancer of the prostate
Information for patients
Radiotherapy Department
This document can be provided in different languages and
formats. For more information please contact:
The Trust endeavours to ensure that the information given here
is accurate and impartial.
Elizabeth Ford, Radiotherapy Department © December 2016 All rights reserved.
Nottingham University Hospitals NHS Trust. Review December 2018 Ref: 1227/v3/1216/
AR.
The Nottingham Radiotherapy Centre
City Hospital
Hucknall Road, Nottingham, NG5 1PB
Tel: 0115 962 7976
Public information
This leaflet is aimed at people who have been diagnosed with
cancer of the prostate. This leaflet aims to provide information
regarding radiotherapy treatment for prostate cancer.
Radiotherapy for prostate cancer
Your doctor has suggested that you have radiotherapy treatment
for the cancer in your prostate. Your doctor will discuss what
alternative treatments are available to you, should you decided
not to have radiotherapy.
Location of the prostate gland
The prostate is a small, walnut sized gland found below the
bladder and in front of the rectum. See the image below.
Useful contacts
If you would like more information or to talk to someone about
how you are feeling then please use the following numbers:
Radiotherapy information and support
Tel: 0115 962 7976
Urology nurse specialists
Nottingham University Hospitals NHS Trust
Tel: 0115 969 1169 ext 54082
King’s mill hospital
Tel: 01623 622 515 ext 6284
Macmillan information centre
The Macmillan information centre is located near oncology
outpatients on the ground floor south corridor on the City
Hospital campus.
Tel: 0115 840 2650
www.macmillan.org.uk
The prostate cancer charity
A voluntary organisation providing information and support to
men affected by prostate cancer and their families.
www.prostate-cancer.org.uk
Maggies centre
Based at Nottingham City Hospital. No appointment is required
and help is available free of charge; with information, benefits
advice and psychological support to anyone affected by cancer.
www.maggiescentres.org
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Getting to radiotherapy
Radical external beam radiotherapy
Radiotherapy is situated on two sites within the City Hospital
campus. The radiotherapy centre is located on St Francis Way
at junction N18 on the north corridor, and the south
radiotherapy department is located on the south road at
junction S2 on the south corridor. You will be informed which
site you need to attend. A map is available on how to find both
sites.
This is a course of X-Ray treatment. The aim of the treatment is
to give a high dose of radiation to your prostate in order to cure
the cancer.
 It is given as an outpatient procedure and takes about 10-15
minutes.
 Treatments are daily, five days a week.
 The number of treatments can vary from five treatment given
over a period of four weeks, up to 39 treatments given over a
period of eight weeks. Your doctor will discuss with you what
is best for you.
 Treatment is painless and it does not involve needles.
There is ‘pay and display’ parking at the hospital. Free parking
permits are available from radiotherapy reception. Please ask
for details.
If you are receiving benefits you may be able to claim your travel
expenses back. Please ask for details at radiotherapy reception.
We can book hospital transport for some people if there is a
medical requirement. If you cannot get to the hospital by your
own means please telephone the radiotherapy department to
discuss your requirements.
If you live a long distance from the hospital and would find
travelling every day difficult, then you may be able to stay in the
patient hotel, located on the City Hospital campus. There is no
charge for patients staying in the hotel while you are having
treatment. Please speak to a member of staff for details.
The type of radiotherapy treatment given is IMRT (intensity
modulated radiotherapy), which is given either as VMAT
treatment on our linear accerators or on our tomotherapy unit.
Your consultant will discuss with you which type of treatment is
best for you.
Some men need a course of hormone treatment to shrink the
prostate before the radiotherapy. This takes three to six
months. It is quite normal to wait this length of time before
starting your radiotherapy treatment. Some men will continue
hormone therapy for many years or indefinitely.
The timeline on page four can be used as a guide to how your
treatments may happen. Please bear in mind that these dates
are approximate and may vary especially if you are in a trial.
Hormone and radiotherapy treatments are arranged to take into
account individual patient needs. Please discuss your particular
pathway with your consultant or information and support
radiographer.
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Hormone
tablets
Your doctor will inform you if you require further hormone therapy after the radiotherapy
has been completed.
Planning for
radiotherapy
Hormone injections
Month
Planning for radiotherapy is over just one appointment and will involve having a CT scan
and in some cases an MRI scan.
Radiotherapy treatment
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2
Hormone treatment/radiotherapy timeline
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You may need to have some help if you live alone, we advise
that you:
 Rest when you feel tired.
 Take some gentle exercise if you feel able.
 Vary your activities to stimulate your interest.
 Use your energy to do things that you enjoy.
Loss of appetite
It is common to lose your appetite when you are recovering from
treatment. We recommend that you:
 Don’t worry if you can’t eat full meals.
 Eat small snacks as often as you can.
 Choose foods that you enjoy.
 Buy foods that are easy to prepare or ready prepared.
 If you’re not eating well it’s important to make sure you still
drink fluids. Aim for two litres per day. Alcohol should be kept
to a minimum.
Follow up appointments
You will be given a follow up appointment to see the oncologist
for between 6 and 20 weeks following your radiotherapy in the
out patient clinic. You will also be given a blood test form to
check your PSA. You can get this blood test done at your GP
surgery and it should be done approximately one week before
your follow up appointment. Please ensure you have this
appointment and the blood test form before your last treatment.
After radiotherapy PSA falls gradually. If your PSA does not fall,
or if it consistently rises during your follow up checks, you may
need further treatment. This is usually a hormone treatment.
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

There may be significant scarring to your rectum. This
happens to less than five percent of treated men.
Exceptionally rarely, the damaged part of bowel that is
causing severe symptoms has to be removed in an
operation. If this happens there is a small risk that you may
need a colostomy (an opening of the bowel onto the front of
the abdomen).
Erectile dysfunction
 Erectile dysfunction (ED) occurs when the nerves used to
send the message to produce an erection are scarred by the
treatment.
 ED means you cannot have a useful erection. It happens for
up to 50% of men who were able to have an erection before
the radiotherapy.
 There are a number of treatments available for ED. Your GP
or the urology team will be able to discuss what is suitable
for you.
Careful radiotherapy planning keeps these significant side
effects to a minimum.
How will I feel during and after my treatment?
This varies from person to person. Some people feel quite well
and are able to carry on very much as usual. However, others
find they get quite tired and feel generally low. Most people feel
well enough to be able to drive or use public transport to get to
the hospital for treatment.
Fatigue (tiredness)
Coping with an unexpected illness and the treatment can be
very tiring both physically and emotionally. You might feel you
don’t have much energy; a bit like when you have flu. Everyday
tasks to run your home may be more difficult than usual.
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Radiotherapy planning
Before treatment can start we have to make sure that the
X-Rays are aimed precisely at your prostate. We need to avoid
treating the normal tissues close to the prostate (bladder and
bowel) as much as possible. This is called treatment planning
and involves:
 A CT scan. Some patients may have an MRI scan as well.
This will be done on the same day as your CT scan.
 At this appointment the radiographers will make some
permanent skin marks on your pelvis to use as reference
points for your treatment. If you would prefer not to have
permanent skin marks then please discuss this with the
radiographers who will be doing your scan.
 A series of mathematical calculations are performed. These
usually take about six weeks to be completed and checked.
You do not need to come to the hospital again until they are
completed.
 You will be scanned each day on the treatment machine
prior to the treatment itself. This is to help us ensure the
accuracy of your treatment position only and does not tell us
how well your treatment is working.
 If you treatment is split into two parts you may have a repeat
planning scan during the treatment to plan the next section
Preparing for radiotherapy to the prostate
To help with your treatment your consultant would like you to
follow a low fibre diet. Ideally you should start this diet two
weeks prior to your planning appointment however if we have
contacted you with less than two weeks notice then please start
the diet as soon as possible. We will also ask you to administer
a micro-enema (supplied at first appointment) before your
planning scan and before each of your treatments. This is to
empty your rectum and help move it away from the area we
need to treat and so reduce possible side effects from the
radiotherapy. There is a separate leaflet on ‘preparing for
radiotherapy to the prostate or prostate bed’ which explains this
in more details. Please ask for this leaflet if it is not sent to you
with your planning appointment.
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Will I have any side effects during radiotherapy?
Your bladder and part of your bowel are very close to your
prostate. This means that the treatment will cause some
inflammation in these areas. Side effects build up gradually and
vary from person to person. After two or three weeks you may
experience some or all of the following:
Bladder
 The lining of your bladder and urethra may become inflamed
by the treatment. This can cause discomfort when passing
urine.
 You will probably need to pass water more often than usual.
 You may find that the urine flow is very weak or hesitant.
 You will probably find you have to get up more times in the
night to pass urine.
 You are more prone to having urine infections during
treatment. We may ask you to do regular urine samples so
that we can test it for infection.
 It is not unusual to pass small pieces of tissue or clots with
your urine. You should not worry about this but inform the
radiographers if it happens.
 It is very important to drink plenty of fluids - at least two litres
per day. This fluid should be water, fruit juice or squash. If
you cut down on your drinks it will not relieve your side
effects, and may make you more likely to develop a urine
infection.
 Intake of caffeine and alcohol should be reduce as they can
irritate the bladder.
Bowel
Part of the bowel is very close to your prostate and so will be
included in the treatment area. Inflammation of the bowel may
cause some diarrhoea. It’s important to tell the radiographers if
you experience diarrhoea so we can advise you how to manage
it.
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Skin
You may see some reddening of the skin in the treatment area.
This is unlikely to be troublesome but we will give you some
cream to use throughout your treatment to keep the skin well
moisturised.
These side effects will gradually settle down over the four to six
weeks after your treatment has finished.
Will I have any long term side effects after
radiotherapy?
Normal tissues recover after radiotherapy but some changes will
have taken place. This can sometimes cause the following
symptoms:
Bladder changes
There will be some scarring of the bladder which may cause
thinning of the bladder lining. This could make it bleed more
easily and you might see blood in your urine from time to time.
Some people find that they have to empty their bladder more
frequently as the bladder doesn’t hold as much fluid.
Bowel damage
 Bowel damage usually shows itself within two years of
finishing treatment. Men with circulation problems, or who
have had an operation in the abdomen, have a higher risk of
bowel damage.
 The symptoms you may get with bowel damage include:
 Opening your bowels more times in a day.
 Feeling that you need to get to the toilet more quickly.
 Passing blood or slime in your motions (intermittently).
 Feeling a need to go but not passing much faeces
(tenesmus).
 Very rarely there can be mucous discharge from your
rectum.
(continued overleaf)
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