Radiotherapy: What are the side effects and ways of managing them?

Radiotherapy uses X-rays to destroy cancer cells. A low dose can be used to shrink the cancer and relieve some symptoms (such as swollen lymph nodes). Radiotherapy can also slow down the cancer’s growth in the treated areas and reduce the amount of pain-relieving medications you are taking.

There are two main types of radiotherapy – external beam radiotherapy (EBRT) and brachytherapy. The difference is whether radiotherapy is applied from outside the body (EBRT) or inserted directly into the prostate (brachytherapy).

Possible side effects from EBRT may include:

Urinary and bowel problems

Radiotherapy can irritate the lining of the bladder and the urethra as well as the bowel. This can cause side effects such as discomfort and difficulty when passing urine, frequent urination and incontinence. Bowel problems can be mild and include looseness and frequency of bowel motions or incontinence. Occasional bleeding from the pack passage (rectum) may occur. 

‘There was a continence nurse and they came along and explained a lot of the things that were supplied like the incontinency aids … I’ve had to find what suits me by experimenting with the products that were available around the place.’

Tips: 

  • Talk with members of your healthcare team (e.g. continence nurse, physiotherapist) about pelvic floor exercises. 
  • Use products (e.g. pads) that could help with concerns you may have when in public. A continence nurse can offer suggestions about the best products for your needs. 
  • Speak to your treating radiation oncologist, a continence nurse or a bowel specialist if you have any bleeding from the back passage and about options for managing these problems. 
  • Talk with members of your healthcare team (e.g. dietitian) about a diet that could improve your bowel function.

Sexual difficulties

Your ability to have erections can be affected over time because of the damage the treatment can cause on nerves that control erections. When you ejaculate, it may be painful and there may be less semen or no semen at all because of the effect the treatment has on the prostate and urethra.

Tips: 

  • Medications – Some medications in tablet and injectable forms can be prescribed to manage erectile difficulties. Because these medications can have side effects, discuss with your healthcare team if they are suitable for you. 
  • Implants/devices – If you don’t want to use medications, vacuum devices that draw blood into the penis (e.g. vacuum erection device) or the use of penile implants (e.g. flexible rods or inflatable tubes) could be ways of getting an erection. Members of your healthcare team (e.g. urologist, nurse, sex therapist) can provide you with information about these. 
  • Think about other ways that you could enjoy sex without penetration (e.g. oral sex, kissing, masturbation or mutual masturbation). 
  • Talk with your sexual partner(s) about what feels good for you and to ask what feels good for them. 
  • Talk to your treating healthcare team about being referred to a health professional (e.g. psychologist, sex therapist) or service that specialises in sexuality matters.

Skin discomfort

You may experience some skin discomfort at the site of the radiotherapy. 

Tips: 

  • When washing, use water at a comfortable temperature and non-perfumed soap. 
  • Keep skin clean and dry. 
  • Wear loose-fitting clothing. 
  • Check your skin regularly to look for any changes (such as soreness, a rash or redness) or broken skin that might lead to infection. 

Fatigue

Your energy level may drop during and shortly after your treatment because of the effect the treatment has on the whole body. Fatigue can also be caused by the demands of having treatment (e.g. travelling to the treatment centre), the chores that need to be done even when feeling unwell, and the emotional stress of living with the disease. 

Tips: 

  • Make sure you get plenty of rest by taking regular breaks during the day. 
  • Do what you have to do when you have the most energy. 
  • Plan ahead and prioritise activities so you only do those that are necessary. 
  • Ask for help so you don’t feel you have to do everything. 
  • Do some light exercise (e.g. short, easy walks) to help you feel less tired. 

Infertility

Radiotherapy can cause fertility problems because it damages the cells that make semen, and can affect your ability to have an erection. [Please see Section 5 for ways of managing this issue.] 


Possible side effects from brachytherapy may include:

Soreness

After treatment, you may experience some soreness in the area where you were treated. 

Tip: 

  • Discuss with a member of your healthcare team about ways the soreness can be managed.

Bowel and urinary problems

Because the bowel and bladder are close to the prostate, the radiation can affect these organs in ways that can cause changes to your toileting routine (e.g. diarrhoea, or needing to urinate more often), as well as other bowel and urinary problems such as blood in your urine or faeces, or discomfort when urinating. These effects could be less severe than those you get with EBRT because the treatment is localised to the prostate more accurately. [Please see the EBRT section above for ways of managing these issues.]

Sexual difficulties

Your ability to have erections can be affected over time because of the damage the treatment can cause to nerves that control erections. It is also possible that when you ejaculate, there is less semen because of the effect the treatment has on the prostate. Initially you should wear a condom as the ejaculate may be bloodstained. [Please see the EBRT section above for ways of managing these issues.] 

Fatigue

Your energy level may drop during and shortly after your treatment because of the effect the treatment has on the whole body. Fatigue can also be caused by the demands of having treatment (e.g. travelling to the treatment centre), the chores that need to be done even when feeling unwell, and the emotional stress of living with the disease. [Please see the EBRT section above for ways of managing these issues.]

Infertility

Radiotherapy can cause fertility problems because it damages the cells that make semen, and can affect your ability to have an erection. [Please see Section 5 for ways of managing these issues.]