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Prostate Cancer: Radiation Therapy

Medically Reviewed by Jennifer Robinson, MD on May 17, 2022

Radiation therapy, also called X-ray therapy, uses high levels of radiation to kill prostate cancer cells or keep them from growing and dividing while minimizing damage to healthy cells.

Radiation can be given from a machine outside the body and directed at the prostate (external radiation). Or a surgeon can place radioactive materials into the tumor (internal radiation or brachytherapy). These radioactive materials can be temporary (removed after the proper dose is reached) or permanent.

Who Might Benefit From Radiation Therapy?

Your doctor might recommend radiation therapy in several situations.

It can be the first treatment for cancer that hasn’t spread outside your prostate gland and is “low grade.” The grade is a number that tells you how abnormal your cancer cells look under a microscope. The lower the grade, the more normal-looking your cancer cells are – and, in general, the more likely your cancer is slow-growing.

Radiation, along with hormone therapy, might also be part of your first cancer treatment if the disease has spread beyond your prostate into nearby tissues.

If you get surgery for prostate cancer, your doctor might recommend you get radiation therapy afterward, too. It can be helpful if the surgeon couldn’t remove all of the cancer or if the cancer comes back in the area of your prostate.

If you have advanced prostate cancer, radiation could help keep the disease under control for as long as possible. It can also help prevent or ease symptoms that the cancer might cause.

What Happens on Treatment Days?

If you get external radiation therapy, you’ll need to get regular sessions (generally 5 days per week) during a period of about 5 to 8 weeks.

For each treatment, the radiation therapist will help you onto the treatment table and into the correct position. Once the therapist is sure you’re positioned well, they’ll leave the room and start the radiation treatment.

They’ll watch you closely during the treatment. Cameras and an intercom are in the treatment room, so the therapist can always see and hear you. Try to stay still and relaxed during treatment. Let the therapist know if you have any problems or you feel uncomfortable.

They’ll be in and out of the room to reposition the machine and change your position. The treatment machine won’t touch you, and you’ll feel nothing during the treatment. Once the treatment is done, the therapist will help you off the treatment table.

The radiation therapist will take a port film, also known as an X-ray, on the first day of treatment and about every week thereafter. Port films verify that you’re being positioned accurately during your treatments.

Port films don’t provide diagnostic information, so radiation therapists can’t learn about your progress from them. But these films do help the therapists make sure they’re delivering radiation to the precise area that needs treatment.

Why Are There Marks on My Skin?

Your radiation therapist will make small marks resembling freckles on your skin along the treatment area. These marks provide targets for the treatment and are a semi-permanent outline of your treatment area.

Don’t try to wash these marks off or retouch them if they fade. The therapist will re-mark the treatment area when necessary.

Will My Diet Affect My Treatment?

Yes. Good nutrition is an important part of recovering from the side effects of radiation therapy.

When you eat well, you have the energy to do the activities you want to do, and your body is able to heal and fight infection. Most importantly, good nutrition can give you a sense of well-being.

Since eating when you don't feel well can be hard, let your treatment team know if you’re having trouble. You could also consider working with a dietitian. They can help make sure that you’re getting enough nutrition during your radiation therapy.

These tips might help while you’re going through treatment:

Try new foods. Things that you haven’t liked in the past may taste better to you during treatment.

Power up with plant-based foods. They can be healthy and tasty substitutes for meat. So for instance, swap out a burger or chicken for beans and peas at a few meals each week.

Eat a rainbow of fruit and vegetables. Get your fill of these healthy powerhouses every day. Good options include spinach, raspberries, yellow peppers, carrots, and cauliflower.

Limit or avoid unhealthy choices. That includes red or processed meats, sugary foods and drinks, and processed foods.

Aim to stay at a healthy weight during treatment. You can ask your doctor what your ideal range on the scale should be. It’s normal to have small weight changes while you go through treatment.

Try to stay physically active. If you’re not active now, you can ask your doctor how to move more and exercise safely.

What Side Effects Will I Have?

During your treatment, radiation must pass through your skin. You may notice some skin changes in the area exposed to radiation.

Your skin may become red, swollen, warm, and sensitive, as if you have a sunburn. It may peel or become moist and tender. Depending on the dose of radiation you receive, you may notice hair loss or less sweat within the treated area.

These skin reactions are common and temporary. They’ll fade gradually within 4 to 6 weeks after you finish your treatment. If you notice any skin changes outside the treated area, tell your doctor or nurse.

Long-term side effects, which can last up to a year or longer after treatment, may include:

  • A slight darkening of the skin
  • Enlarged pores
  • Skins feels more or less sensitive
  • A thickening of tissue or skin

Other possible side effects of external beam radiation therapy are:

Tiredness. Your fatigue might not lift until a few weeks or months after you finish getting radiation therapy.

Lymphedema. If radiation therapy damages the lymph nodes around your prostate gland, the fluid can build up in your legs or genital area. That can bring on swelling and pain. Physical therapy can usually treat lymphedema, but it might not go away completely.

Bowel problems. Radiation can irritate your rectum and bring on a condition called radiation proctitis. You might get diarrhea, bloody stool, or have trouble controlling when you poop. Most of these side effects fade eventually. Your doctor may tell you to follow a special diet during treatment to minimize bowel trouble.

Urinary problems. Radiation can irritate your bladder, and that could lead to a condition called radiation cystitis. You might:

  • Have to pee more often
  • Feel like it burns when you pee
  • Notice blood in your urine

Problems like these usually get better over time, but for some people they don’t go away.

There’s also a chance you’ll have trouble controlling your urine, or it may leak or dribble. That’s part of a condition called urinary incontinence. It’s a side effect that happens less often with radiation than after surgery, though.

One rare side effect of radiation therapy for the prostate is that the tube that carries urine from your bladder out of your body, called the urethra, could become too narrow or close off. If that happens, you’ll need more treatment to open it back up.

Erection problems. These can include impotence, or trouble getting or maintaining an erection. If you get erection problems after radiation therapy, they usually develop slowly over time rather than right away. The older you are, the higher your chances for trouble getting erections. Your doctor has treatments, including medicines, that can often help.

Keep these side effects in mind when you think about your treatment options. If you have any concerns, don't hesitate to speak up.

And while you’re going through treatment, talk to your doctor about any side effects you have. Ask for ways to get relief.

How Can I Reduce Skin Reactions?

  • Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Don’t rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
  • Try not to scratch or rub the treated area.
  • Don’t put any ointment, cream, lotion, or powder on the treated area unless your radiation oncologist or nurse has prescribed it.
  • Don’t wear tight-fitting clothing or clothes made from harsh fabrics like wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers like cotton.
  • Don’t apply medical tape or bandages to the treated area.
  • Don’t expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
  • Don’t expose the treated area to direct sunlight. That could intensify your skin reaction and lead to a severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.

Will Radiation Therapy Make Me Tired?

Everyone has their own energy level, so radiation treatment will affect each person differently.

People often feel fatigue (tiredness) after several weeks of treatment. For most, this fatigue is mild. But some people lose a lot of energy and need to change their daily routine.

If your doctor thinks you should limit how active you are, they’ll discuss it with you.

To minimize fatigue while you’re receiving radiation treatment:

  • Get enough rest.
  • Eat well-balanced, nutritious meals.
  • Pace yourself, and plan rest breaks throughout your day.

What Is Conventional Radiation Therapy?

This older type of radiation therapy uses 2-D “flat” X-ray images to guide and position radiation beams.

Newer techniques that use 3-D images can help doctors deliver radiation more precisely to cancer cells while helping protect healthy cells.

What Is 3D Conformal Radiation Therapy?

It’s a procedure that uses a computer to make a three-dimensional picture of your tumor. It helps your treatment team deliver the highest possible dose of radiation to the tumor while minimizing the damage to normal tissue.

3D conformal radiation therapy uses CT-based treatment combined with three-dimensional images of a prostate tumor. CT is short for computed tomography, which uses X-rays to produce detailed pictures inside the body.

So far, this technique has worked well for localized tumors such as prostate cancer limited to the prostate gland.

General Guidelines

  • All patients have a CT scan specifically for radiation therapy treatment and planning.
  • The CT data is electronically transferred to the 3D treatment planning computer.
  • The doctor defines the area to be treated along with surrounding areas, like the bladder, rectum, bowel, and bones.
  • An optimal radiation beam and dose are analyzed using a 3D computer-generated model.
  • When the exact dose of radiation to the prostate is determined, the patient returns for a treatment simulation.
  • The simulation process transposes or maps the computer-generated plan to the patient. The doctor will review the treatment course and side effects with the patient.

Side Effects

  • You may have hair loss in the area of your body getting radiation.
  • Nausea and vomiting aren’t common unless you get radiation therapy on your upper belly area.
  • If you have mild fatigue, you might be able to stick to your normal routine during treatment, including working full time.
  • You may need to pee often, have a weak urine stream, or feel mild burning when you pee.
  • It’s possible to have diarrhea, though uncontrolled diarrhea is rare. Because the radiation beam passes through normal tissues -- like the rectum, bladder, and intestines -- on its way to the prostate, it kills some healthy cells. You may get diarrhea as a result.
  • Some possible long-term problems are proctitis (inflammation of the rectum) with bleeding, incontinence, and impotence.

What Is Intensity-Modulated Radiotherapy (IMRT)?

It’s an advanced approach to 3D conformal radiation therapy. The IMRT technique is very precise.

It uses computer-generated images to plan and then deliver tightly focused radiation beams to prostate cancer tumors. It lets your treatment team vary the beam intensity to "paint" a precise radiation dose to the shape and depth of the tumor. It also reduces the harmful effects of doses on healthy tissue.

Studies show that higher-dose rates delivered with IMRT techniques improve the rate of local tumor control.

Other techniques that are being used or studied include:

  • Image-guided radiation therapy (IGRT). This uses radiation machines with built-in scanners that allow for minor adjustments before radiation is given.
  • Volumetric modulated arc therapy (VMAT). This delivers radiation quickly while beams rotate around the body.
  • Stereotactic body radiation therapy (SBRT). This uses advanced image-guided ways to deliver a large dose of radiation to a very specific place in the prostate. The entire treatment is usually done in just a few days.

What Is Brachytherapy?

This is a type of internal radiation. For this treatment, a surgeon places radioactive pellets (also called “seeds”) about the size of a grain of rice directly into your prostate. They use imaging tests to help them place the pellets correctly, and computer programs to figure out the exact dose of radiation you need.

In general, getting brachytherapy alone is only an option for some people with early-stage prostate cancer that’s growing relatively slow. Brachytherapy plus external radiation might be an option if your cancer is more likely to grow outside your prostate gland.

You get brachytherapy in a hospital operating room. Before the procedure, you’ll get anesthesia to either numb your body or help you sleep. You may need to stay in the hospital overnight.

The two types of brachytherapy for prostate cancer are:

Permanent brachytherapy. Your doctor may also call this “low dose rate” brachytherapy. The pellets give off low doses of radiation for weeks or months. They’re very small and rarely cause pain, so doctors usually leave them in your prostate after they stop giving off radiation.

Temporary brachytherapy. Your doctor may also call this “high dose rate” brachytherapy. Doctors don’t use it as often as the permanent type. Temporary brachytherapy gives off higher doses of radiation for a short time. In general, you need up to four quick treatments over 2 days, and your treatment team removes the radioactive material each time.

Some possible side effects of brachytherapy are:

  • Swelling, bruising, bleeding, or pain around the spot where you got treatment
  • Short-term urinary symptoms like incontinence or pain while peeing
  • Diarrhea, constipation, and rectal bleeding
  • Erectile dysfunction

What Is Proton Beam Radiation Therapy?

This type of therapy treats tumors with protons instead of X-ray radiation. It may be able to deliver more radiation specifically to a prostate cancer tumor with less damage to normal tissue. 

Proton beam therapy might be a safe treatment option when a doctor decides that using X-rays could be risky for a patient. But so far, research hasn’t shown that it works better than traditional radiation therapy against solid cancers in adults.

The side effects of proton beam therapy are similar to the ones that other types of radiation treatment bring on. But since proton therapy may be less damaging to normal tissue, the side effects might be milder.

After treatment, you may gradually have ones like:

  • Fatigue or low energy
  • Sore, reddened skin around the area where you got treated
  • Hair loss around the treatment spot

One of the disadvantages of proton therapy is that it might not be covered by all insurance companies. You’d need to check with your health plan to find out.

Proton therapy also isn’t widely available. You can get it only at certain centers in the U.S. 

Other Questions About Radiation Therapy

Who can I contact if I have concerns about my treatment?

Many hospitals and clinics have a staff social worker who can help you during your treatment. Check with your doctor to see if this is available to you.

The social worker can discuss any emotional issues or other concerns about your treatment or your personal situation, and they can give you information about resources. They can also discuss housing or transportation needs if you need.

People dealing with certain medical issues find it helpful to share experiences with others in the same situation. Your doctor can give you a list of support groups if you’re interested. Your social worker can offer more information about finding support, and you can look online for support group resources.

What about follow-up care?

After your radiation therapy sessions are complete, you’ll visit your doctor for regular follow-up exams and tests. Your doctor will tell you how often to schedule your follow-up appointments.

You can also ask your doctor for a survivorship care plan. This outlines things like:

  • The treatment you received
  • What side effects you may get in the short and long term
  • Who should be following you for testing and care

Show Sources

SOURCES: 

American Cancer Society: “Radiation Therapy for Prostate Cancer,” “Radiation Therapy Side Effects,” “Cancer Therapy,” “Eating Well During Treatment.”

OncoLink: “Radiation Therapy: Which type is right for me?”

Memorial Sloan Kettering: “What Is Brachytherapy?”

National Cancer Institute: “3D-CRT.”

Johns Hopkins: “Proton Therapy.”

Mayo Clinic: “Proton Therapy.”

American Urological Association.

FDA.

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