Treatment

Radiotherapy for advanced prostate cancer

Men with prostate cancer that has spread outside the prostate to other parts of the body (advanced prostate cancer) may have radiotherapy to help relieve symptoms. This is called palliative radiotherapy. Palliative radiotherapy doesn't aim to get rid of your cancer but it can help to slow down its growth.

There are two types of radiotherapy to help relieve symptoms.

  • External beam radiotherapy (EBRT) uses high energy X-ray beams which are directed at the area of pain from outside of the body.
  • Radioisotope treatment involves an injection of a very small amount of a radioactive substance.

Radiotherapy may be used to treat symptoms such as pain, blood in the urine, and swollen lymph nodes. It can also be used to treat a rare condition called metastatic spinal cord compression (MSCC) when cancer cells grow in or near to the spine and press on the spinal cord. You can read more about MSCC in our fact sheet, Metastatic spinal cord compression.

What other treatments are available?

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What are the advantages and disadvantages?

The advantages and disadvantages depend on your general health, previous treatment and how far your cancer has spread.

Advantages:

  • Radiotherapy may help relieve your symptoms for several months and improve day-to-day life
  • It may slow down the growth of the cancer in the area that's treated
  • Treatment works quite quickly. You should have some pain relief within a few weeks
  • You might be able to reduce the dose of any pain-relieving drugs you're taking. This could be useful if they are causing side effects.

Disadvantages:

  • Like most treatments, radiotherapy can cause side effects
  • You might have slightly more pain during treatment, and for a few days afterwards. This should soon improve
  • The pain can come back after several months. If this happens, you might need further treatment with radiotherapy or other treatments.

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What does treatment involve?

External beam radiotherapy (EBRT)
Before starting EBRT you will go to a planning session.

You'll have either one single dose or a series of smaller doses of radiotherapy spread out over a week or more.

At the beginning of each treatment, the radiographers will help move you into the right position on the treatment couch. The radiotherapy machine moves around your body and will make a slight noise. It doesn't touch you and you won't feel anything. You'll need to lie still, but the treatment only lasts a few minutes. You should be able to go home after the treatment has finished.

If you have pain in several areas of your body, you may have hemi-body radiotherapy. This is radiotherapy to half your body - the upper or lower half, depending on where you have pain.

Radioisotopes
Treatment with radioisotopes can be helpful if you have pain in more than one area. Tell your doctor if you are taking prescription or over-the-counter medicines, or you have a history of blood disorders, bone marrow problems or kidney disease.

Strontium-89 (Metastron®) is a radioisotope that can be used to relieve pain in men with advanced prostate cancer. A very small amount is given as an injection into a vein in your arm.

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After treatment

Your doctor will monitor you and your symptoms. Pain can sometimes get worse during treatment and for a few days afterwards - called a pain flare.

You should notice that the pain gradually improves, though it might take a few weeks for the treatment to be most effective. The pain relief usually lasts for several months.

If your pain or symptoms don't improve, you may be offered another course of radiotherapy or a different treatment to help control symptoms. You can read about these in our fact sheet Managing pain in advanced prostate cancer.

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What are the side effects?

EBRT
There are usually few side effects from EBRT. If you have hemi-body radiotherapy you might have more side effects because a larger area of the body is treated. These are some of the most common side effects of EBRT and hemi-body radiotherapy.

  • Some men feel tired for a week or two after treatment finishes
  • Your skin might get darker and itch in the area treated, similar to sunburn. Avoid using any creams, lotions or perfumed soaps unless you are advised to do so by your doctor, radiographer or nurse
  • Radiotherapy to your ribs or spine can make you feel or be sick - anti-sickness medication can help treat this
  • Radiotherapy to your lower body can lead to loose and watery stools (diarrhoea) - there are medications to help treat this
  • You might have slightly more pain during the course of treatment or for a few days after it has finished - this should soon get better.

Radioisotopes

Most side effects of strontium-89 only last a short time and are not severe.

  • Some men have more pain in the days after treatment, but this should only last for a few days
  • Sometimes the bone marrow is affected which might change the way that your blood clots and increase your risk of infection and anaemia. You may get a fever, chills, bruising, bleeding or tiredness. It is rare for infection or anaemia to be severe, but you might need regular blood tests after treatment
  • You may feel or be sick (nausea or vomiting) or have diarrhoea. This is not common.

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Questions to ask your doctor or nurse

  • How will radiotherapy help me?
  • What other treatments are available to help me with my pain?
  • Which type of radiotherapy is best for me?
  • How long will the pain relief last?
  • Will there be any side effects from the treatment? What can help with these?
  • Are there any precautions that I need to take during and after treatment?
  • Who should I contact if I have any questions at any point during my treatment? How do I contact them?
  • Will having this treatment mean I am unable to have other types of treatment later on (for example, chemotherapy)?

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References

You can find a list of references used to produce this page in our online fact sheet.