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Radiotherapy Department
Colchester Hospital
Tel: 01206 745 055

A guide for patients having radiotherapy to the prostate or prostate bed

What is radiotherapy?

Radiotherapy is a treatment for cancer which uses high energy x-rays. It is carried out using a machine called a Linear Accelerator or ‘Linac’

Having radiotherapy is similar to having a scan. It is painless and you need to lie still while you are on the treatment couch.

Radiotherapy is usually (but not always) given as a series of treatment sessions between Monday to Friday. The number of treatments will depend on each patient’s specific treatment needs.

The treatment is carefully planned, however some healthy cells in the treatment area can be affected which can cause some side effects.

The treatment will not make you radioactive and it is safe for you to be with other people, including babies, children and pregnant women, throughout your treatment.

Support for radiotherapy patients

Macmillan Radiotherapy Advanced Practitioners

These are therapy radiographers with extensive experience in all aspects of radiotherapy treatment and care who provide:

• a direct contact to give support and specialist radiotherapy advice for you and your relatives and carers before, during and after a course of radiotherapy
• time for you and your family to talk through the information you have been given and discuss any concerns you may have
• a link with all doctors, nurses and other health care professionals involved in your care, both in the hospital and in the community. We can also refer you on to other health professionals or services, if necessary.

Please ask a member of staff if you would like to speak to us or contact us by phone on 01206 745 025.

We endeavour to answer your call straight away but if you leave a message for us we aim to respond within one working day.

Prescription medical exemption

All people undergoing treatment for cancer can apply for an Exemption Certificate by collecting a form FP92A from their GP surgery or oncology clinic / treatment department.

Arrival

The main entrance to the Radiotherapy Department is behind Gainsborough Wing (diagonally opposite the Constable Wing Entrance). Alternatively you may use the main front entrance to the hospital and follow signs to the Radiotherapy Department.

Coming to the department – by car

Patients undergoing radiotherapy treatment do not have to pay to park at the hospital. There is a car park designated for Radiotherapy patients beside the Radiotherapy main entrance behind Gainsborough Wing. You will be given information about entry to this car park when you are informed about your first radiotherapy appointment.

Coming to the department – by train or bus

Travel information is on our getting to Colchester Hospital page

Hospital transport can only be booked if you are not well enough to make your own way, or you have no alternative means of private or public transport available.

Important
If you use hospital transport, you should be prepared to be away from home for at least four hours. Therefore, if you take regular medication or are diabetic please make sure you have what you need with you when you come.

Children

Please note that this hospital does not have a child‑minding service. Children who cannot be left unattended cannot be looked after by departmental staff.

Important Information

Sometimes we advise you not to father a child during and for some time after your radiotherapy treatment. If you have further questions on issues regarding fertility before your radiotherapy, please discuss this with your radiotherapy consultant.

Clothing and gowns

We may ask you to change into a gown and remove your shoes for your planning appointments and for all your radiotherapy treatments.

For this reason it may be helpful for you to wear clothes that are easily removed, including slip-on shoes if you have them or you may prefer to bring some slippers. We will ask you to wear shoes or your slippers to go between the changing room and the treatment rooms, to prevent any slips or falls.

Please note: you may be asked to remove your gown while you are on the couch for your planning and treatment.

Planning your radiotherapy

The planning of your treatment will involve two separate telephone appointments followed by a planning appointment in the Radiotherapy Department’

What will happen at your first telephone appointment

You will be asked for permission to send in the post to you some information and medication to prepare your bowel and bladder for your radiotherapy planning appointment.

You will also  be given the date of your next telephone appointment

Please note – It is very important that you read the information you are sent before the second telephone appointment

What will happen at your second telephone appointment?

A member of the radiotherapy staff will explain to you how to prepare your bladder and bowel for your radiotherapy planning appointment. You will be given the date of the radiotherapy planning appointment.

What will happen at your Radiotherapy planning appointment?

For the next stage of your planning process you will have a CT scan.

CT Scanner

You will be asked to arrive one hour before your scan. This is so that you can follow the bladder filling process in the Radiotherapy Department. Please do not do this at home. You will be taken into a room where you will be given water to drink. Your treatment will be discussed and you will be asked to sign a consent form to say you agree to have radiotherapy.

Before the CT scan we will check the volume of fluid in your bladder using our ultrasound bladder scanner.

After the scan we will ask your permission to make some tiny permanent ink marks with a pin prick on your skin. They are no bigger than a full stop (.) and will be used as reference points for all the measurements for your treatment. This will ensure treatment is accurate each day. You may hear us refer to these as ‘Tattoos’. If you have any concerns about having these markings please let us know when you attend your treatment planning appointment.

You may be asked to remain in the department while your scan is checked.

Occasionally it may be necessary for the scan to be repeated and you may be given another appointment for this.

If the scan does not need to be repeated you will be given a provisional list of the dates and times of you treatment appointments. Please be aware that occasionally these may change.

Your next appointment

The information and measurements that we obtain from the CT planning session will be passed on to our Physics Department who will use it to produce a computerised treatment plan specifically for you. This is a complicated process and usually takes one to three weeks to complete.

Your treatment

You will need to follow the instructions given to you about preparing your bowel and bladder before each treatment.

When you arrive for your treatment, please report to reception.

The volume of fluid in your bladder will be checked using our ultrasound bladder scanner before treatment for the first few treatments, and on other occasions if needed.

Before your treatment you will be asked to change into a hospital gown and you will then be taken into a treatment room.

Radiotherapy treatment machine, also known as a Linear Accelerator

The radiographers will ask you to lie on the treatment couch. They will spend a few minutes positioning you correctly and precisely for your treatment. It is important at this stage that you remain as still as you can.

The radiographers switch on the machine from outside the room so, when all the adjustments have been made, they will leave while you have your treatment. The machine makes a noise when it is operating so you will know when it is on.

This is the only time you will be left alone. However, the radiographers are able to see you on CCTV and they can also hear you over the intercom, in the treatment room.

The radiographers will take an X-ray image to check your treatment position and bladder and bowel filling. If it is not satisfactory you may be asked to leave the room and given further instructions about your bowel or bladder filling.

This is quite normal and nothing to worry about. We will always explain exactly what we would like you to do. You will then be asked to return and the X-ray image will be repeated prior to the treatment machine being switched on.

This routine will be the same every time you come for treatment until your course is completed.

How long will it take?

After only a few minutes your treatment will be over. Exactly how many minutes it will take varies but you are likely to be in the treatment room for 10 to 20 minutes. The treatment process will take longer if adjustments need to be made to your bowel and bladder filling.

How long will you be in the department?

We hope that you will be in the department no longer than 45 to 60 minutes each visit but this may vary. If you travel by hospital transport, however, you will be here quite a lot longer than that. The transport is unable to take you back until all the patients who came with you have also been treated. Patients are also reviewed by other members of the team during their course of radiotherapy and on these days you may expect to be in the department longer. Sometimes these reviews may be done by telephone.

Side effects of radiotherapy

Your normal routine need not be greatly affected but you may feel tired. Although radiotherapy is completely painless, it is a very powerful treatment and does have some side effects. These vary depending not only on how much treatment you receive but also which part of the body is being treated. Some people are more sensitive to radiation than others and are more likely to experience side effects.

Unfortunately, there is no way of identifying these people before they are treated.

Please note that if you have a short course of treatment (fewer than ten treatments) you are less likely to have significant side effects.

If side effects do occur, they will usually develop during the second half of your treatment and could last for some time after your treatment has finished. Recovery rates vary from person to person, so it is difficult to give an exact time for how long they will last.

Possible side effects

Fatigue

You may feel tired during your radiotherapy treatment, because the body has to repair damage caused by the radiotherapy to healthy cells. It can often be made worse by having to travel to hospital each day, or by other treatments such as surgery or chemotherapy.

What can be done?

• There’s good evidence that physical activity can actually help to reduce the symptoms of fatigue. Get plenty of rest but balance this with some gentle exercise, such as short walks if you are able. This will give you more energy and help to keep your muscles working
• Save some energy for doing the things you enjoy and ask others for help doing chores if these are tiring you out
• Eating well can help to boost your energy levels
• Drink plenty of fluids

Bladder problems

As we have already mentioned, tissues in the treated area can be irritated by the treatment. When treating the prostate, a small amount of your bladder may be in the treatment field. This can cause:

• feeling the need to pass urine more often
• a burning sensation when passing urine

What can be done?

• Drink plenty of fluids – at least four pints (two litres) per day (about eight mugs)
• You may find that some drinks such as those containing caffeine or alcohol may irritate your bladder and it may help if you avoid these
• If needed the staff can provide you with a card to show in shops and other public places asking for you to be given access to a toilet quickly

Let the radiographers know if you experience any of these bladder symptoms so you can be checked for urinary infection.

Bowel problems

When treating the prostate, a small amount of your bowel may be in the treatment field. This can cause diarrhoea.

What can be done?

• It may be necessary for you to modify your diet if you get diarrhoea. We can give you advice on what to try
• Drink plenty of fluids
• If altering your diet doesn’t work, let the radiographers know so you can be given medication to help

Proctitis

This is when the rectum and / or anus become inflamed from the radiotherapy treatment. This may cause pain in the back passage when you open your bowels. You may also pass some mucus and blood when opening your bowels.

What can be done?

Let the radiographers know if you are experiencing proctitis and we can then get you something to help ease this.

Further information for gay and bisexual men

It is advisable to abstain from receiving anal sex during and for a few weeks after your course of treatment. If you would like more information, please ask a member of your Radiotherapy team. The information booklet ‘Prostate facts for gay and bisexual men’ is available at the Prostate Cancer website (Opens in a new window).

Alternatively it can be requested on your ‘Booklet request form’ or from the Macmillan Radiographers

Sore, skin (erythema)

During your radiotherapy and for a while afterwards, you may develop a skin reaction in the area being treated. You may notice:

• your skin gradually becoming pinker or darker, depending on your skin colour
• the skin may feel dry or tight, and sore
• a rash may also appear and feel itchy.

A skin reaction may appear at any time but usually begins about ten days after starting treatment. If you are having less than ten radiotherapy treatments you are unlikely to experience a significant skin reaction.

What can affect my skin reaction?

• Having treatment to areas where there are skin folds can make your skin reaction worse. This includes the groin or between the buttocks because they can be warm, moist and rub together causing friction
• Smoking can make your skin reaction worse – if you need help to stop please ask for advice
• A skin reaction is more likely if you are overweight, due to more skin folds

A member of the radiotherapy team will talk to you about your usual daily skin care routine. He or she will let you know if any changes are advised. Please share any worries you have.

Skincare for patients having radiotherapy treatment

It may not be possible to stop a skin reaction but by following this advice you may feel more comfortable.

Important – this only applies to the skin in the area being treated. Please ask the treatment staff if you are unsure of the exact area of skin which will be affected by your treatment.

• Wash the skin gently with soap and warm (not hot) water; gently pat dry.
• Avoid tight clothing in the treatment area.
• Wear loose-fitting, natural fibre clothing next to the skin. Avoid rubbing the area.
• Avoid extremes of temperature such as heating and cooling pads, hot water bottles and microwaveable wheat bags.
• Avoid sticky tape on the area (such as ElastoplastTM or MicroporeTM).
• It may also help to reduce irritation to the treated area if you use a moisturiser sparingly – gently smooth it on and apply in the direction of hair growth. Please stop using if it irritates your skin and talk to your treatment team. Aquamax cream (available from pharmacy counters) and E45 cream are examples of suitable moisturisers. If you’re choosing a new moisturiser, one that is free from sodium lauryl sulphate would be best. Ask the team if you are unsure about the cream you wish to use.
• Do not wipe moisturiser off before treatment. If your skin breaks /blisters you should stop using moisturiser. Your treatment team will advise you further.
• Avoid using products containing alcohol on the skin.
• You may swim if your skin isn’t broken. Shower after swimming to wash off the chlorine and apply your moisturiser. Please stop swimming if it irritates your skin.
• Avoid sun exposure and protect the area from direct sunlight. Be careful in the sun for at least a year after you have finished. Use a sunscreen with a minimum UVB sun protection factor (SPF) of 50 and UVA protection as your skin will be more sensitive.
• Your treatment team will let you know if this advice changes during treatment.

Important – Please stop using any particular product which you think may be irritating your skin in the treatment area and ask your treatment team for advice. It may help to keep up a good fluid intake and eat a nutritionally well-balanced diet.

As your treatment progresses

Your oncologist will oversee your planning and treatment and you will be monitored daily by the Radiotherapy team.

Please always make sure that you let the radiographers know if you get any side effects.

If you have a concern about side effects or problems that you wish to discuss and your appointment is after 3pm, please call ahead well before your appointment time.

The radiographers may advise you to come earlier to be seen by the appropriate member of the team.

What happens if you miss any treatments?

Right at the beginning of your course of treatment we will give you the dates and times of all your treatment appointments. Ideally, you should not miss any of these appointments. If you are ill and unable to come, however, or something unforeseen happens which stops you having your treatment, your missed appointment(s) will be re‑organised.

They will usually be added on to the end of your list. If you miss an appointment, please check with the radiographers to find out exactly what will happen in your case.

End of treatment Summary

 You will be reviewed at the end of your course of treatment by a member of the review team. You will be given a copy of your ‘End of treatment Summary’. This document gives information about your treatment, your side effects and about your follow up and is for both you and your GP.

 After your treatment finishes

Side effects of radiotherapy often reach their peak 7 to 14 days after treatment has finished. They will then gradually settle and improve. Again, it is very hard to put an exact timescale on it because everyone’s recovery rate is different.

Remember

We are always available if you experience problems or simply need reassurance. You will find a list of contact numbers at the end of this leaflet.

Important

Continue following our skincare advice for two weeks after your treatment has finished, and then start to return to your normal routine.

Useful contacts

Macmillan Advanced Radiotherapy Practitioners
01206 745 025
Monday to Friday, 8.30am – 4.30 pm

Radiotherapy Reception
01206 745 055

Appointments
01206 745 033

Radiotherapy nurses
01206 745 037

Urology Clinical Nurse Specialists
Colchester Hospital 01206 742 964
Broomfield Hospital 01245 514 499

Wellbeing Centre and Macmillan Cancer Information Centre Colchester General Hospital
01206 745 347

Macmillan Cancer Information Centre Broomfield Hospital
01245 515 981

Macmillan Cancer Support (Opens in a new window)
Freephone 0808 808 0000

Prostate Cancer UK (Opens in a new window)
Freephone 0800 074 8383

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