About Your Radiation Therapy After Prostate Surgery

This information will help you get ready for radiation therapy to your prostate after your prostate surgery. It’ll help you know what to expect and how to care for yourself before, during, and after your radiation therapy.

Read through this resource at least once before you start radiation therapy. After that, use it as a reference in the days leading up to your treatments to help you get ready. Bring this resource to all your appointments with your radiation therapy team. You and your radiation therapy team will refer to it throughout your care.

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About Radiation Therapy

Radiation therapy uses high-energy radiation to treat cancer. It works by damaging cancer cells and making it hard for them to multiply. Your body can then naturally get rid of the damaged cancer cells. Radiation therapy also affects normal cells, but your normal cells can repair themselves in a way that cancer cells can’t.

Before your first radiation treatment, you’ll have a treatment planning procedure called a simulation. During your simulation, your radiation therapists will take imaging scans, make a mold of your lower body, and mark your skin with little tattoo dots. These things are done to:

  • Map your treatment site.
  • Make sure you get the right dose (amount) of radiation.
  • Limit the amount of radiation that gets to your nearby tissues.

Radiation therapy with hormone therapy

You may have radiation therapy alone or along with hormone therapy. The goal of hormonal therapy is to kill prostate cancer cells. It’s often done along with radiation therapy.

For more information about hormone therapy, read the resource Hormonal Therapy for People with Prostate Cancer .

Your role on your radiation therapy team

You’ll have a team of healthcare providers working together to care for you. You’re part of that team, and your role includes:

  • Getting to your appointments on time.
  • Asking questions and talking about your concerns.
  • Telling someone on your radiation therapy team when you have side effects.
  • Telling someone on your radiation therapy team if you’re in pain.
  • Caring for yourself at home by:
    • Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at 212-610-0507.
    • Caring for your skin as instructed.
    • Drinking liquids as instructed.
    • Taking your bowel preparation medications as instructed.
    • Avoiding certain foods and drinks as instructed.
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Before Your Radiation Therapy

Sperm banking

During your radiation treatments, your testes will be exposed to radiation. This can affect your sperm production and ability to have biological children in the future.

If you think you may want to have biological children after radiation therapy, we recommend banking your sperm before you start treatment. For more information, read the resources Sperm Banking and Building Your Family After Cancer Treatment: Information for Men.

Bowel preparation

You’ll need to clear extra stool (poop) from your body for your simulation and radiation treatments. This is called bowel preparation. Bowel preparation helps lower your risk of side effects by limiting the amount of radiation that gets to nearby healthy tissues.

Supplies

You’ll need the following supplies:

  • Methylcellulose dissolvable fiber supplement (such as Citrucel® powder)
  • Simethicone 125 milligram (mg) tablets (such as Gas-X® Extra Strength)

You can buy these at your local pharmacy without a prescription.

Instructions

A member of your radiation therapy team will tell you exactly when to start your bowel preparation. You’ll start at least 3 days before your simulation appointment and continue until your last radiation treatment.

For your bowel preparation:

  • Take 1 tablespoon of methylcellulose powder every morning. Dissolve the powder in liquid following the instructions on the package.
  • Take 2 (125 mg) tablets of simethicone every night.

Keep taking the methylcellulose powder and simethicone tablets every day until you finish your radiation therapy.

 

Vitamins and dietary supplements

It’s OK to take a multivitamin during your radiation therapy, but don’t take more than the recommended daily allowance (RDA) of any vitamin or mineral.

Don’t take any other dietary supplements without talking with a member of your radiation therapy team. This includes vitamins, minerals, and herbal or botanical remedies.

Remove devices from your skin

If you wear any of the following devices on your skin, the manufacturer recommends you remove it before your simulation or treatment:

  • Continuous glucose monitor (CGM)
  • Insulin pump

Talk with your radiation oncologist about whether you may need to remove your device before your simulation or treatment. Make sure you have an extra device with you to put on after your simulation or treatment.

If you’re not sure how to manage your glucose while your device is off, talk with the healthcare provider who manages your diabetes care before your appointment.

Simulation appointment

The morning of your simulation appointment:

  • Take 1 tablespoon of methylcellulose powder as usual.
  • Take 2 (125 mg) tablets of simethicone about 2 hours before your appointment. These are in addition to the tablets you usually take at night.

During your simulation, you’ll stay in one position for about 2 hours. If you think this will be hard for you, you should also take acetaminophen (Tylenol®) or your usual pain medication 1 hour before your appointment.

When you arrive

When you arrive for your simulation, a member of your radiation therapy team will check you in. Your radiation therapists will also greet you and communicate with you throughout your appointment.

You’ll be asked to say and spell your full name and date of birth many times. This is for your safety. People with the same or a similar name may be having care on the same day as you.

When it’s time for your simulation, you’ll change into a hospital gown. Keep your shoes on.

Your radiation therapists may also ask you to drink 8 to 12 ounces of water before your simulation starts. This is to fill your bladder. Having a comfortably full bladder and empty bowel during your treatments will help limit the amount of radiation that gets to your healthy tissue. This helps lower your risk of side effects.

During your simulation

Once you’re ready, your radiation therapists will help you lie on your back on the treatment table (see Figure 1). The table will have a sheet on it, but it’s hard and doesn’t have a cushion. If you haven’t taken pain medication and think you might need it, tell your radiation therapists before your simulation starts. Also, the room is usually cool. If you feel uncomfortable at any time, tell your radiation therapists. They’ll do everything they can to make sure you’re comfortable and have privacy.

Figure 1. Simulation and treatment machine

Figure 1. Simulation and treatment machine

Throughout your simulation, you’ll feel the table move into different positions. The lights in the room will be turned on and off and you’ll see red or green laser lights on each wall. Your radiation therapists use these laser lights as a guide when they position you on the table. Don’t look directly into the laser. If you do, it may damage your eyes.

Don’t move once your simulation starts. It’s important that you stay in the same position. If you’re uncomfortable or need help, tell your radiation therapists.

Your simulation will take about 2 hours but can be shorter or longer depending on your specific treatment. Your radiation therapists will walk in and out of the room during your simulation, but there will always be someone who can see and hear you. You’ll hear your radiation therapists talking to each other as they work. They’ll also talk with you about what they’re doing. Your therapists can play music for you to help pass the time.

Imaging scans

Your radiation therapists will use a computed tomography (CT) scanner to make sure you’re in the right place and position on the table. They may also use a magnetic resonance imaging (MRI) scanner.

Positioning (mold)

Once you’re in the right position on the table, your radiation therapists will make a mold of your lower body.

To make the mold, your radiation therapists will put a warm, flexible plastic sheet over your lower body and shape it to fit around you. The plastic will form a hard mold as it cools. This procedure takes about 15 minutes.

Your radiation therapists will put the mold over you and attach it to the table for your simulation and all your treatments. This will help make sure you’re in the exact same position every time.

Skin markings (tattoos)

Your radiation therapists will also use a felt marker to draw on your skin in the treatment site. Then, they’ll make about 4 to 6 tattoos using a sterile needle and a drop of ink. Each tattoo will feel like a pinprick. The tattoos won’t be bigger than the head of a pin.

After they make the tattoos, your radiation therapists will take several photographs of you in your simulation position. The photographs and tattoos will be used to position you correctly on the table each day of your treatment.

You can wash off the felt markings after your simulation. The tattoos are permanent and won’t wash off. If you’re concerned about having tattoos as part of your radiation treatment, talk with your radiation oncologist.

Scheduling your radiation treatments

You’ll schedule your radiation treatment appointments before you leave your simulation appointment. Radiation treatments can be given Monday through Friday for 8 to 10 weeks. Each radiation treatment appointment will take about 1 to 2 hours.

Your radiation therapy will be ____ weeks long.

You must come to every one of your radiation treatment appointments. Your radiation therapy may not work as well if you skip or miss treatments. If you can’t come in for a treatment for any reason, call your radiation oncologist’s office to tell your radiation therapy team. If you need to change your schedule for any reason, speak with your radiation therapists.

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During Your Radiation Therapy

Remember to keep taking methylcellulose powder and simethicone tablets every day until your finish your radiation therapy.

Radiation treatment appointments

The morning of your radiation treatment appointment:

  • Take 1 tablespoon of methylcellulose powder as usual.
  • Take 2 (125 mg) tablets of simethicone about 2 hours before your appointment. These are in addition to the tablets you usually take at night.

During your treatment, you’ll stay in one position for about 20 minutes. If you think this will be hard for you, you should also take acetaminophen (Tylenol) or your usual pain medication 1 hour before your appointment.

When you arrive for your radiation treatment appointments, a member of your radiation therapy team will:

  • Check you in.
  • Ask you to visit the restroom and try to have a bowel movement (poop) so there’s no stool (poop) or gas in your rectum during your treatment.
  • Give you 8 to 12 ounces of water to drink about 45 minutes before your treatment, if needed. This helps make sure your bladder is comfortably full during your treatment.

You’ll also change into a hospital gown. You can keep your shoes on.

During your radiation treatments

When it’s time for your treatment, your radiation therapists will bring you to the treatment room and help you onto the treatment table. You’ll be positioned exactly how you were during your simulation. Your radiation therapists will do everything they can to make sure you’re comfortable during your treatment. Then, they’ll leave the room and start your treatment.

Breathe normally during your treatment, but don’t move. Your radiation therapists will be able to see you on a monitor and hear you through an intercom during your whole treatment. Tell them if you’re uncomfortable or need help.

Neither you nor your clothes will be radioactive during or after treatment. It’s safe for you to be around other people.

Status check visits

Your radiation oncologist and radiation nurse will see you once each week to check how your treatment is going, ask about any side effects you’re having, and answer your questions. This is called a status check visit. This visit may be scheduled before or after your treatment.

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Side Effects of Radiation Therapy to Your Prostate

Some people have side effects from radiation therapy. The type and severity of side effects varies from person to person. Your healthcare provider will talk with you about what to expect based on your medical history and specific treatment plan.

This section explains the most common side effects of radiation therapy to the prostate. You may have all, some, or none of these. Most of these side effects will go away several weeks to months after you finish radiation therapy. If you have any of these side effects, your healthcare provider will give you more information and help you manage them.

Urinary changes

About 2 weeks after your first radiation treatment, you may:

  • Have trouble starting to urinate (pee).
  • Need to urinate more often than usual.
  • Need to urinate at night more often than usual.
  • Have sudden urges to urinate.
  • Leak urine.
  • Feel a burning sensation when you urinate.

Tell your doctor or nurse if you have any urinary changes. They can recommend a change in your diet or prescribe medication that can help. You can also follow the guidelines below.

  • Drink 6 to 8 glasses of water throughout the day.
  • Avoid drinking after 8:00 pm.
  • Avoid foods and drinks that may irritate your bladder, such as:
    • Caffeine (such as tea, coffee, soda)
    • Alcohol
    • Spicy foods (especially if you feel burning when you urinate)
    • Acidic fruit juices and fruit products (such as tomatoes and tomato juice)
  • Do pelvic floor muscle (Kegel) exercises.

Read the resource Pelvic Floor Muscle (Kegel) Exercises for Men to learn how to do Kegel exercises. A member of your radiation therapy team will tell you how many to do and how often to do them.

Bowel changes

About 2 weeks after your first radiation treatment, you may:

  • Have bowel movements (poop) more often than usual.
  • Have softer stool than usual.
  • Feel discomfort in your rectum (the area where stool is stored before bowel movements).
  • Have mucous discharge from your anus.
  • Pass more gas than usual.
  • Feel like you need to have bowel movements more urgently than usual.

If you have hemorrhoids, radiation therapy can make your hemorrhoid symptoms worse.

These side effects are usually mild.

When you start radiation therapy, you can follow your usual diet. If you develop any of these side effects, talk with your nurse about how to change your diet to manage them. If you’re still uncomfortable, tell your doctor or nurse. They can prescribe medication to help.

Read the resource Diarrhea for more information.

Sexual and reproductive health

You can be sexually active during your radiation therapy, unless your radiation oncologist gives you other instructions. You won’t be radioactive or pass radiation to anyone else.

If you’re sexually active with someone who’s able to get pregnant, it’s important to use birth control (contraception) during and for 1 year after your radiation therapy. During your radiation therapy, your sperm may be damaged by the radiation. If you conceive a baby with this sperm, the baby might have birth defects. Using birth control helps prevent this.

For more information about your sexual health during cancer treatment, read the resource Sex and Your Cancer Treatment. The American Cancer Society also has resources about sexual health issues during cancer treatment. The one for men is called Sex and the Adult Male with Cancer. You can search for it at www.cancer.org or call 800-227-2345 for a copy.

Male Sexual and Reproductive Medicine Program

MSK’s Male Sexual and Reproductive Medicine Program helps people address the impact of their disease and treatment on sexual health. You can meet with a specialist before, during, or after your treatment. We can give you a referral, or you can call 646-888-6024 for an appointment.

Fatigue

Fatigue is a feeling of being tired or weak, not wanting to do things, not being able to concentrate, or feeling slowed down. You may develop fatigue after 2 to 3 weeks of radiation therapy, and it can range from mild to severe. Fatigue may last 6 weeks to 12 months after your last radiation treatment.

There are many reasons why you may develop fatigue during treatment, including:

  • The radiation’s effect on your body.
  • Traveling to and from your treatments.
  • Not having enough restful sleep at night.
  • Not eating enough protein and calories.
  • Having pain or other symptoms.
  • Feeling anxious or depressed.
  • Certain medications.

You may find that your fatigue is worse at certain times of the day.

Managing fatigue

If you have pain, diarrhea (loose or watery bowel movements), trouble sleeping, or feel depressed or anxious, tell a member of your radiation therapy team. They may prescribe you medication or refer you to one of the following support services. You can also request an appointment by calling the numbers below.

  • Counseling Center
    646-888-0200
    Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
  • Integrative Medicine Service
    646-888-0800
    MSK’s Integrative Medicine Service offers patients many services to complement traditional medical care. These include music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Below are other suggestions to help you manage your fatigue.

  • If you’re working and are feeling well, it’s OK to keep working. But working less may help you have more energy.
  • Plan your daily activities. Pick the things you need or really want to do and do them when you have the most energy. For example, you may go to work but not do housework or watch your child’s sports event but not go out to dinner.
  • Plan time to rest or take short (10- to 15-minute) naps during the day, especially when you feel more tired.
  • Try to sleep at least 8 hours every night. This may be more sleep than you needed before you started radiation therapy. You may also find it helpful to:
    • Go to sleep earlier at night and get up later in the morning.
    • Be active during the day. For example, if you’re able to exercise, you can go for a walk, do yoga, or visit the gym.
    • Relax before going to bed. For example, you can read a book, work on a jigsaw puzzle, listen to music, or do calming hobbies.
  • Ask family and friends to help you with things like shopping, cooking, and cleaning. Check with your insurance company to see if they cover home care services.
  • Some people have more energy when they exercise. Ask your doctor if you can do light exercise, such as walking, stretching, or yoga. Read the resource Managing Cancer-Related Fatigue with Exercise for more information.
    • Avoid riding a bicycle during your radiation therapy. Riding a bike can put pressure on your prostate area. It’s OK to use an inclined bike.
  • Eat regular meals. Your doctor may recommend following a low-fat, low-fiber diet and avoid gas-producing foods.
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After Your Radiation Therapy

Follow-up appointments

After you finish your radiation therapy, a member of your radiation therapy team will tell you how often to see your doctor or nurse practitioner for follow-up appointments. You may have follow-up blood tests (such as PSA tests) during these appointments. Keeping your follow-up appointments will also help your healthcare provider identify and treat any late side effects (side effects that happen 4 or more months after treatment).

Vitamins and dietary supplements

If you took dietary supplements (such as vitamins or herbal remedies) before your treatment, you can start taking them again 1 month after your last radiation treatment. If you’d like to speak with a clinical dietitian nutritionist about your diet or supplements, ask your nurse to arrange this.

Urinary and bowel changes

Radiation therapy can cause permanent urinary and bowel changes. Many people don’t notice any changes or have any symptoms. However, some people have late side effects.

Late side effects may be similar to the ones you had during treatment. There’s a very small chance you may develop other side effects. For example:

  • The opening of your bladder may become narrower.
  • You may lose your ability to control your bladder.
  • You may have blood in your urine.
  • You may have bleeding from your rectum.
  • Your rectum may be injured.

These side effects are rare. They may come and go over time or be persistent and chronic. Your healthcare team will help you manage them.

Even if you don’t develop any late side effects, remember that the tissues in your bladder and rectum were affected by your radiation therapy. Call your radiation oncologist if you:

  • Have any new urinary, bladder, or bowel symptoms.
  • Need to have a colonoscopy. Avoid having a colonoscopy for the first year after radiation therapy.
  • Need any type of urological or rectal procedure.

Sexual changes

Some people develop sexual changes after radiation therapy. For example:

  • It may be more difficult or not possible to get or keep an erection. This is called erectile dysfunction (ED).
  • Your orgasms may feel different.
  • When you ejaculate, the amount or thickness of your semen may be different.
  • You may not ejaculate when you orgasm.

These changes may happen many months or years after radiation therapy. They may be permanent. If you notice any of them, tell your healthcare provider. They can give you a referral to a doctor who treats these problems.

 
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Contact Information

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at the numbers listed below.

Radiation oncologist: _____________________
Phone number: _________________________

Radiation nurse: ________________________
Phone number: _________________________

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the radiation oncologist on call.

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the radiation oncologist on call.
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