What to Expect After Radiation Treatment for Prostate Cancer

If you were diagnosed with prostate cancer and your doctors have recommended radiation therapy, you might be wondering what to expect after the treatment course. Please continue reading to learn more about the after-effects of prostate cancer radiation therapy.

How does radiation therapy treat prostate cancer?

Radiation therapy kills prostate cancer cells using high-energy rays. There are different types of radiation therapy for prostate cancer, including:

Brachytherapy

Low-dose rate brachytherapy is a type of internal radiation in which healthcare providers place seeds (radiation sources) inside the prostate gland using anesthesia. These seeds give off radiation over a period of several weeks to months to kill cancer cells. High-dose-rate (HDR) brachytherapy delivers radiation quickly in a few minutes, and the radiation material is removed immediately afterward.

External beam radiation therapy (EBRT)

This is a type of external radiation in which high-energy rays are delivered to the prostate from outside. The different types of external beam radiation therapy for prostate cancer include:

Intensity-modulated image-guided radiation therapy (IG-IMRT), which is typically given over a 5-week period
Stereotactic body radiation therapy (SBRT), which involves the use of sophisticated imaging techniques to deliver radiation precisely to cancer cells in the prostate
Hypofractionated radiation therapy, which consists of 5 treatments over one and a half weeks
Radiopharmaceuticals, which involve the injection of medications containing radiation sources into the body to target cancer cells that have spread from the prostate to healthy tissues in other parts of the body

Your cancer care and treatment team may recommend other treatments for prostate cancer with or without radiation therapy treatment, such as surgery, chemotherapy, hormone therapy, immunotherapy, and targeted therapy. The treatment plan will depend on whether you have early-stage prostate cancer (localized prostate cancer) or advanced disease.

What are the most common side effects of radiation?

Side effects after radiation therapy for prostate cancer occur because, along with cancerous cells, the radiation beams also destroy some healthy cells. Healthy tissue near the treatment area is most affected, and therefore, side effects tend to be localized here.

Most of the side effects of radiation therapy for prostate cancer go away in just a few days to weeks, but in some cases, they can linger and have a longer-lasting effect. The severity and duration of the side effects depend on the treatment protocol and exact dose. Higher doses tend to cause more severe side effects.

Possible side effects of external beam radiotherapy for prostate cancer

Radiation proctitis: Exposure of the rectum to external radiation therapy can lead to bowel problems such as rectal irritation, pain, burning, diarrhea, blood in stool, and fecal incontinence. Your doctor may place a spacer between the prostate and rectum during the radiation treatment to reduce exposure. Eating a special low-fiber diet to limit bowel movements during radiation therapy sessions may also help.
Radiation cystitis: Irritation of the urinary bladder by radiation beams can lead to a condition called radiation cystitis. Symptoms include urinary problems such as frequent urination, burning with urination, blood in urine, urinary incontinence, and urethral stricture (narrowing).
Erectile dysfunction: Some men experience problems achieving and maintaining erections after radiation treatments for prostate cancer. These problems tend to develop over time rather than immediately after the radiation dose. Erectile dysfunction can be an adverse effect of radiation therapy; however, overall fatigue and mental health problems such as depression and anxiety are also contributing factors.
Fatigue: Tiredness can persist for a few weeks to months after completing radiation therapy.
Lymphedema: Damage to the lymph nodes around the prostate gland can result in the collection of lymph fluid in the legs and/or genital area. This is called lymphedema, and it can cause pain and swelling. Physical therapy may provide relief.
Skin problems: Redness, itching, and peeling in the treatment area are rare.

Possible side effects of brachytherapy for prostate cancer

Side effects after brachytherapy for prostate cancer are similar to external beam radiation therapy and include bowel problems, urinary problems, and erection problems.

Possible side effects of radiopharmaceuticals for prostate cancer

Side effects of radiopharmaceuticals include fatigue, dry mouth, nausea, constipation, and loss of appetite. Treatment can also lead to low blood cell counts:

Low red blood cells can cause tiredness, weakness, shortness of breath and pale skin;
Low white blood cells can cause an increased risk of infections with symptoms such as fever, chills, sore throat;
Low platelets can cause easy bruising and bleeding.

What causes more side effects: brachytherapy or external beam radiation therapy?

Generally speaking, brachytherapy tends to cause fewer side effects since it targets a smaller area than external beam radiation therapy.

Some studies have shown that erection problems are less likely after brachytherapy compared to external beam radiation. However, other studies have found these problems occur at the same rate as external beam radiation and surgery. The difference is that erection problems occur right after surgery but develop gradually over time, up to a year after a treatment course of external radiation and brachytherapy.

The type of prostate radiation also influences the severity of side effects. Treatment options such as proton beam therapy use protons instead of the X-rays used in standard radiation therapy. Protons cause less damage to normal surrounding tissue as they make their way to a prostate tumor. Therefore, proton therapy can deliver more radiation to the cancer while causing less damage to surrounding normal tissues, thereby causing fewer side effects.

Other factors can affect the severity of side effects. For example, younger men with better sexual function before treatment are more likely to regain erectile function after radiation treatments. Similarly, better urinary and bowel function before treatment is associated with higher chances of full recovery.

How long is recovery after prostate cancer treatment?

Most side effects of prostate cancer radiation therapy are significantly better 3-4 weeks after completing treatment. You may be able to continue working and living an otherwise normal life during your treatments. Full recovery can take 3-6 months, however. Your radiation oncologist, doctor, or nurse can give you a better estimate of the timeline of recovery based on the protocol used to treat prostate cancer.

What not to do after radiation treatment?

Radiation precautions

You might have to take some precautions if you have permanent (low-dose-rate or LDR) brachytherapy or radiopharmaceuticals, in which the radiation source remains in your body for several weeks or months. Your clinical oncology team may advise you to stay away from small children and pregnant women. Find out “Can Radiation Be Given Twice In The Same Area?”

Travel

If you plan to travel after LDR brachytherapy, you may need a note from your medical oncologist in case the low levels of radiation from the radioactive material are detected by airport security systems.

Brachytherapy seed migration

There is a small risk that brachytherapy seeds might migrate out of the prostate gland. Your doctor may ask you to strain your urine to catch any seeds that are expelled. They may also ask you to use a condom during sex. These precautions are not needed after high-dose-rate (HDR) brachytherapy because the radiation source is removed from your body after treatment.

Kidney injury

Radiopharmaceutical drugs can cause kidney injury. Follow your doctor’s instructions and drink plenty of water during treatment to protect your kidneys. Tell your doctor if you develop urinary problems such as decreased urination.

Diet and rest

Avoid caffeine, alcohol, and citrus juices that can make your bowel and bladder symptoms worse.

Get enough rest and sleep to give your body time to recover. Some people need to take time off work to recover from prostate cancer treatment.

Continuing treatment

Talk to your doctor about taking diarrhea medications if loose bowel movements are a concern.

Keep all your medical and lab appointments during further treatment. Your health care team may want to check PSA levels and blood counts.

How do you know radiation is working?

You know radiation therapy for prostate cancer is working if your pre-treatment symptoms improve. Your doctor may order imaging tests to see if the cancer is shrinking. You should know that prostate cancer may respond to treatment right away or after several weeks or months. Your radiation therapy team will give you more information.

What is the life expectancy of someone who has had radiation for prostate cancer?

According to the National Cancer Institute and American Cancer Society, the 5-year relative survival rate for men with prostate cancer is 97%. This means five years after diagnosis and treatment, a prostate cancer patient is only 3% less likely to be alive than someone who didn’t have prostate cancer. This is especially true in the early stages. This is why screening for prostate cancer in men is recommended.

Prostate cancers have some of the best outcomes among cancers. However, various factors, such as the stage at discovery (advanced versus localized prostate cancer) and cancer treatment, can affect survivorship.