Prostate Cancer Radiation Therapy FAQs

Radiation, Hormone Therapy

Q. What Is Prostate Cancer Radiation Therapy?

A. Prostate cancer radiation therapy is another form of treatment for prostate cancer. It includes external beam radiation therapy (EBRT) and brachytherapy. EBRT is usually done after other surgery, to manage high-risk recurring cancer. It has a very good success record. It provides long-term disease control and survival rates equivalent to treatments like surgery.

Q. What Are The Disadvantages of Prostate Cancer Radiation Therapy?

A. Prostate cancer radiation therapy can cause many side effects. Some are minor and diminish after therapy is stopped. The side effects include fatigue, skin inflammation in the treated areas, frequent or uncomfortable urination and rectal bleeding or irritation. Some prostate cancer radiation therapy side effects, however, are permanent. Bowel function may never become normal even after treatment is stopped. Impotence can occur up to 2 years after prostate cancer radiation therapy in some patients.

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Q. What Can Be Expected During Prostate Cancer Radiation Therapy?

A. EBRT is similar to having a routine X-ray. Radiation is not seen, smelled or felt and side effects don't occur until 2 or 3 weeks into treatment. Prostate cancer radiation therapy is a local treatment so only the areas of the body where it is administered will experience side effects.

Most patients experience some or all of the following prostate cancer radiation therapy side effects:

  • Burning or tingling with urination
  • Difficulty starting urination or weak urinary stream
  • Hemorrhoids or rectal irritation with some blood
  • Increase in urination frequency and urgency
  • Infrequent, softer and smaller volume bowel movements
  • Occasional diarrhea

Depending on the severity of these side effects, patients will be given anti-diarrheal medications or a medication to decrease the frequency of urination. Most symptoms are short-lived and diminish after the prostate cancer radiation therapy ends. Otherwise, patients typically continue with their normal daily activities during treatment.

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Q. Are There Post-Therapy Effects After Prostate Cancer Radiation Therapy?

A. After completing prostate cancer radiation therapy, urinary and bowel side effects may continue for 2 to 6 weeks, but they will go away over time. Patients may need to continue some medications. Fatigue affects some patients for several weeks post-treatment. Other problems may include dry itchiness, "heaviness" in the perineum, anal and rectal irritation, and hemorrhoids. However, patients are usually not bothered enough to discontinue normal daily activities.

With brachytherapy, seeds or small radioactive pellets, are placed inside or next to the treatment area. Another type of brachytherapy requires needles to administer radioactive material for short periods of time.

With brachytherapy prostate cancer radiation therapy, patients may experience the following:

  • Blood in the urine, usually just after the procedure
  • Blood spotting from the perineum
  • Burning with urination
  • Fatigue
  • Incomplete bladder emptying
  • Increased frequency of urination
  • Nausea from anesthesia
  • Perineal pain or soreness
  • Scrotal bruising or swelling
  • Slow or weak urinary stream

Most patients are able to resume normal daily activities shortly after prostate cancer radiation therapy. However, heavy lifting and strenuous physical activity should be limited for two to three days after the procedure. In some cases, swelling of the prostate may obstruct the bladder and the patient may need a catheter and medicine to help reduce swelling and inflammation. The catheter usually can be removed after 3 to 7 days. Some patients may experience rectal discomfort after the procedure. Rectal bleeding is uncommon.

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Q. What Else Should I Be Aware Of With Prostate Cancer Radiation Therapy?

A. Patients are given detailed written instructions about the following:

Prostate Cancer Radiation Therapy – Radiation does not remain in the body once treatment is done and it is completely safe to be in contact with other people. With permanent seed brachytherapy, the tissues absorb the radiation from the implant. Any items which are touched, including bodily waste, are radioactive. However, during the first couple of months after permanent seed brachytherapy, patients should maintain a distance of 6 feet or more from pregnant women or those trying to conceive. Avoid close physical contact with young children and pets for long periods of time.

Sexual function – Sexual intercourse can be resumed after the seed implant but condoms should be worn during the first week after the procedure. Most men experience erectile dysfunction after prostate cancer radiation therapy. The likelihood of prolonged impotence is determined by age, the use and duration of prostate cancer radiation therapy, smoking and other medical conditions, such as hypertension and diabetes, as well as certain medications. For most men, erectile dysfunction diminishes slowly over the first 2 years post-treatment. Men who are not on medications containing nitrate can use oral medications that improve erectile quality with great success.

Patients may experience a longer time to reach orgasm after prostate cancer radiation therapy. Some notice change in the nature of their ejaculate, such as thicker or less fluid or a decrease in the quantity or an absence of ejaculate after treatment, more so with EBRT than brachytherapy. After brachytherapy, the ejaculate may be discolored, dark-brown or even black. This is due to "old" blood from the procedure. It is harmless and will eventually clear.

Sperm production – Prostate cancer radiation therapy affecting the testicles may lead to a temporary reduction in sperm count and, in some cases, lead to a permanent reduction in sperm count or sterility. Patients who are considering conceiving should seek medical advice regarding fertility and sperm banking.

Testosterone production – The dosage of prostate cancer radiation therapy reaching the testicles is not high enough to impair normal functioning.

On a final note, in a study by Dr. Mark S. Soloway, professor and chairman of urology at the University of Miami, it was found that prostate cancer radiation therapy created a statistically significant higher risk of developing bladder or rectal cancer as compared to those who had undergone radical prostatectomy.

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Q. How Often Should I See My Doctor?

A. Following EBRT, follow-up appointments with the doctor will help monitor the patient's recovery and ensure any side effects are diminishing. The frequency of follow-ups will depend on the risk of cancer recurrence. PSA blood tests will start around the third month after treatment and are repeated every 3 to 4 months during the first 2 to 3 years and then every 6 months. Brachytherapy patients will have a CT scan of the prostate 3 to 4 weeks after the procedure. This scan will evaluate the "quality" of the implant.

Q. How Will I Know If Prostate Cancer Radiation Therapy Is Working?

A. PSA blood tests are used to monitor progress after treatment. Following prostate cancer radiation therapy, the PSA will be low but will not reach its lowest point for couple of years. Also, PSA results often vacillate up and down during the first 3 years after EBRT or brachytherapy; this does not mean treatment failed. After prostate cancer hormone therapy, as testosterone recovers, the PSA may rise and the period of eventual decline may be prolonged;  this is also not a sign of treatment failure. The PSA remains a vital monitoring tool and testing at regular intervals is crucial. In addition to the PSA, the doctor will evaluate other data to monitor treatment outcomes.

Q. Will I Need Additional Treatments?

A. Usually, no additional treatment is needed after prostate cancer radiation therapy. It’s important to note that patients can have radiation after surgery but surgery after radiation is almost impossible. If the prostate is removed, the follow-up is easier because the PSA would always be at zero. With prostate cancer radiation therapy, however, the PSA fluctuates as it had prior to surgery. Regularly scheduled PSA testing is important in evaluating the need for future treatment. Should the cancer return, treatment will, in part, depend upon the initial treatment choice. Additional or alternative forms of radiation therapy may be recommended. Doctors, including a radiation oncologist, urologist, and medical oncologist, will discuss treatment options at that time.

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* The benefits of robotic surgery cannot be guaranteed as surgery is both patient and procedure specific. Previous surgical results do not guarantee future outcomes.

J. Newman

I am pleased and proud to add my comments to the patients list of success stories. I had been affected by BPH (growing prostate) for 10 years.

Yossi, Israel

I chose to undergo the operation with a specialist in the U.S., who has an extensive experience in robotic surgeries: Dr. David Smadi. The surgery was relatively simple: i didn't suffer any pain, lost a small amount of blood and had the catheter only for seven days. I got back to full functioning very soon afterwards.

S. S., USA

I cannot begin to tell you the reaction that I receive when I tell people that I was operated on just three weeks ago and what a remarkable surgeon you are.. I just want to reiterate how fabulous you staff is and how deeply indebted I am to you.

Steve S. New Jersey, USA

Dr. Samadi is a unique person having reached the pinnacle of his profession, while at the same time treating all his patients with compassion as though they are members of his immediate family.