Your doctor has suggested radiation therapy to treat your prostate cancer? This section outlines this treatment and the precautions to ensure everything goes as smoothly as possible.

Procedures for external radiation therapy

Pre-treatment visits

Shortly before starting your treatment, you will meet with your medical team to prepare for your treatment and then begin it. Normally, three visits are planned: one with your radiation oncologist (or more if necessary), one for the implantation of gold or platinum seeds, and one for simulation/planning scan (see Before starting treatment below).

Simulation

Simulation is a planning session performed before the first session of external radiation therapy. It ensures that the radiation will be directed exactly to the same location at each session.

Duration of the procedure

The usual treatment may last for several weeks. Your treatment may be shorter if you are part of a research group or if you are also receiving high-dose rate brachytherapy (another type of radiation therapy). If so, you will receive explanatory documentation on this.

Preparation before your radiation therapy treatments

Proper preparation can make your radiation therapy sessions less difficult than expected, including your transportation or accommodation needs. Additionally, your preparation will play an essential role in a quicker and less stressful recovery. By reading the following on this page. you will know what to expect and how to deal with it.

Are your treatments far from home?

If necessary, contact the Quebec Cancer Foundation for accommodation. It offers affordable, comfortable, and safe accommodation near major radiotherapy centers. Their Hospitality Houses in Montreal, Gatineau, Sherbrooke, Lévis, Quebec City, and Trois-Rivières welcome you and a close companion for the duration of your treatments.

Your diet during your treatments

Although you can eat whatever you want during your radiation therapy treatments, you should expect to make some adjustments to your diet, particularly regarding foods that greatly increase intestinal activity (see The process below). Feel free to ask for a referral to a nutritionist to adapt your diet.

Questions to my doctor

We invite you to consult our page Questions to ask to your doctor and your healthcare team regarding tests and diagnostic exams for prostate cancer. Asking questions will open up communication, provide information tailored to your situation, and reduce the stress associated with understanding the diagnosis of prostate cancer.

Before beginning radiation therapy treatment

You will have several meetings with your radiation oncologist and their team before undergoing your first radiation therapy session. They will take the time to explain your treatment plan, potential side effects, available strategies to anticipate or mitigate them, and the steps leading up to your initial radiation therapy session. By reading the following on this page, you will understand what to expect.

During external radiation therapy

Throughout each session, you will remain in the same position

At the start of each session, technologists ensure technical functionality. They also capture images to locate the prostate using platinum grains. Once your positioning is confirmed, they exit the room. However, an intercom and cameras maintain communication. They can see and hear you, and you can communicate with them.

Following treatment, a technologist will provide the date and time of your next appointment.

Throughout treatment, you will meet regularly with the radiation oncologist to monitor side effects and evaluate progress.

Will I experience pain?

During treatment, you should not feel any discomfort. However, you may encounter side effects after several sessions.

Safety precautions

External radiation therapy does not render individuals radioactive. There is no risk in proximity to others, including children, immediately following treatment.

Your diet during treatment

The radiology team may recommend a low-fiber or low-residue diet throughout treatment. This diet restricts fiber-rich foods, such as whole grain breads and cereals, nuts, seeds, raw or dried fruits, raw vegetables, caffeine, and dairy products high in lactose. The aim is to reduce bowel movements, bloating, and gas, and to alleviate symptoms like diarrhea and/or stomach cramps. For more information, refer to the article “Which foods should I avoid during radiation therapy?

Instructions to follow

Take care of your skin

• Wash the areas treated by radiation with a mild, unscented soap, without lanolin, with a neutral pH. If necessary, seek advice from a pharmacist.
• If needed, your doctor may prescribe a cream to use during the treatment period.
• Do not use any products on the treated skin without consulting your doctor first.
• Wear loose-fitting clothes to reduce irritation to the treated areas. Choose cotton or natural fabrics.
• Cover the treated area to protect it from the sun.
• Do not apply heat or cold directly to the treated area.
• Do not remove the marks made by the team on your skin.

Avoid foods that significantly increase intestinal activity

• Avoid whole grain bread, prunes, dried fruits, cucumbers, nuts, leeks, fermented cheeses (brie, Oka), legumes, large amounts of juice, ice cream…
• Also, reduce your consumption of coffee and milk. A nutritionist can answer YOUR questions, if needed.
• Drink plenty of water.

Activities during treatment

Some people may continue to work and engage in their usual leisure activities while receiving radiotherapy. Others may find themselves getting tired easily and needing more rest. Take a nap when you need it.

Physical contacts and sexual activity are safe after external radiotherapy. Some people may need to take extra care of their skin for a while after treatment.

Medical follow-up

Medical certificate

If you need a medical certificate, remember to request it directly from your radiation oncologist.

Success rate

As with radical prostatectomy, it is impossible to establish a general success rate with radiotherapy.

• This varies depending on each case because the diagnosed tumor grade, its stage of spread, and the PSA level before treatment must be taken into account.
• The lower these data are, the better the chances that the patient will be definitively cured.

PSA test

Digital rectal examination and measurement of prostate-specific antigen (PSA), performed regularly – every three to six months – allow your radiation oncologist to monitor your condition. It is the PSA test that best predicts the risk of prostate cancer recurrence.

Your PSA level

With radiotherapy, it is not expected that the PSA level will drop to 0 ng/mL since there are always normal prostate cells remaining. Usually, the PSA level drops to a plateau and stays there. Your level should start to decrease in the months following the start of treatment. It may even continue to decrease one year after treatment.

At each follow-up appointment, your radiation oncologist will evaluate three parameters:

• if the PSA level increases
• how long after the end of treatment it occurred
• and how long it takes for this level to double (its velocity)

Recurrence

If the PSA level starts to rise, the doctor will monitor how long it takes to double. The shorter these periods, the greater the risk of recurrence and the more aggressive the recurrence will be. For example, a PSA level that starts to rise eight months after the end of treatment and doubles in six months is much more concerning than a PSA level that starts to climb three years after radiotherapy and takes one year to double.

If necessary, hormone therapy may be prescribed. Otherwise, discuss with your radiation oncologist about salvage treatments after radiotherapy.

Remission

You will be monitored for at least five years after your radiotherapy. After seven to ten years without recurrence, the risks of the cancer coming back are low. Advances in radiation techniques have made late adverse effects less frequent and less severe. However, some symptoms may appear several months or years after the end of treatment. The most common problems associated with radiotherapy are urinary, gastrointestinal, and erectile dysfunction.

Side effects

Intestinal and urinary function

Sometimes intestinal and urinary functions do not return to normal at the end of treatment. This occurs in 5% to 10% of men.

• Some medications (such as cortisone, which reduces inflammation of the rectum) and muscle relaxants can sometimes provide relief.
• Request an appointment with a nutritionist or dietitian for your intestinal problems.
• Discuss your urinary problems with your doctor. Often, they can be easily corrected with medication or intervention.

Blood in your urine or stool

• Sometimes blood in the urine (microscopic hematuria) is observed. If you notice blood in your urine, notify your urologist.
• You may also notice blood in your stool. Most often, this is a problem that will disappear quickly at the end of treatment. However, you should discuss this with your doctor who will likely want to consult with a specialist to evaluate the bleeding area.

For more information on urinary and intestinal disorders, see our section on side effects.

Erectile function

The percentage of risk of erectile dysfunction may vary for each patient. However, unlike other side effects, erectile dysfunction appears gradually several months or even years after treatment, but does not affect pleasure.

• As cell death is gradual, you will retain your erectile capacity for several years, but it will decrease over time.
• Your erectile function depends on your sexual function before your treatment, your age, your overall health.
• Your erectile function will be more affected if your radiotherapy is combined with hormone therapy, due to the loss of your libido.

For more information on erectile dysfunction, see our section on sexual disorders.