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 does not aim to get rid of your cancer but it can help to slow down its growth.

There are two types of palliative radiotherapy:

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

Palliative radiotherapy may be used to treat symptoms such as pain, blood in the urine, and swollen and uncomfortable lymph nodes. It can also be used to treat a rare condition called metastatic spinal cord compression (MSCC) where cancer cells spread to the bones of the spine (vertebrae) and press on the spinal cord. You can read more about MSCC in our fact sheet, Metastatic spinal cord compression (MSCC)

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:

  • Palliative radiotherapy may help relieve your symptoms for several months
  • It may slow down the growth of the cancer in the area that is treated
  • Treatment works quite quickly. Within a few weeks you should have some pain relief
  • You may be able to reduce the dose of any pain-relieving drugs you might be taking.

Disadvantages:

  • Like most treatments, palliative radiotherapy may cause side effects
  • You may experience an increase in pain during, and for a few days after, treatment but this should soon improve
  • The pain may come back after several months. If this happens you may need further treatment
  • Your specialist should discuss with you whether you will benefit from palliative radiotherapy, which type of radiotherapy you may have, how long the treatment may take and possible side effects.

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What does treatment involve?

External beam radiotherapy (EBRT)
Before starting EBRT you will go to a planning session. You may have either one single dose or a series of smaller doses of radiotherapy over a week or more.

At the beginning of each treatment a member of staff will help move you into the right position on the table. The radiotherapy machine moves around your body and will make a slight noise. It does not touch you and you will not feel anything. You will need to lie still but the treatment only lasts a few minutes. You should be able to go home afterwards.

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

Radioisotopes
Treatment with radioisotopes can be helpful if you have pain in more than one area. Tell your specialist team 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 which may 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.

After treatment
Your specialist team will monitor you and your symptoms. Pain can sometimes get worse during treatment and for a few days afterwards. It may be a week or more after treatment before your pain starts to improve. The pain relief usually lasts for several months.

If your pain or symptoms do not improve, you may be offered another course of radiotherapy or a different treatment to help control symptoms. You can read about these on our page Pain and 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 may have more side effects because a larger area of the body is treated.

Side effects may include:

  • Feeling tired for a week or two after treatment finishes
  • Darkening of the skin and itching in the area treated, similar to sunburn
  • Feeling or being sick if you have had radiotherapy to your ribs or back bone
  • Loose and watery stools (diarrhoea) if you had radiotherapy to your lower body
  • A slight increase in pain during the course of treatment or for a few days after it has finished. This should soon get better
  • Hemi-body radiotherapy may also affect how well your bone marrow works.

Radioisotopes
Most side effects of radioisotopes only last a short time and are not severe. They may include:

  • An increase in pain a few days after treatment, but this should only last for a few days
  • Changes to the way your blood clots and an increased risk of infection and anaemia. You may get a fever, chills, bruising, bleeding or tiredness
  • Feeling or being sick (nausea or vomiting) or diarrhoea. This is not common.

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Questions to ask your doctor or nurse

  • How will palliative radiotherapy help me?
  • What other treatments are available to help me with my pain?
  • Which type of radiotherapy would be most suitable for me?
  • How long will the treatment 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 treatment?
  • Who should I contact if I have any questions at any point during my treatment? How do I contact them?
  • Will I still need to see my specialist team after my treatment has finished?
  • Will having this treatment mean I am unable to have other types of treatment (for example, chemotherapy) later on?

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References

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