Oregon Urology Institute

Radiation Center

Potential Side Effects

The side effects of external beam radiation therapy tend to be less severe than the side effects of other prostate cancer treatments. Doctors will often use external radiation therapy for prostate cancer patients who want to avoid the risks of surgery. Generally, no pain is associated with external radiation therapy, and the associated side effects tend not to interfere with daily life. There is also a lower occurrence of urinary side effects associated with external radiation therapy.

Severe incontinence occurs in fewer than 2 percent of men who undergo external radiation therapy. Temporary incontinence or urinary leakage, frequency, burning during urination, and difficulty urinating or urinary retention are associated with external radiation therapy. Patients may also see blood in their urine, feces, or semen. These symptoms tend to go away on their own within a few weeks. Some patients may also experience acute urinary retention and may require a Foley catheter for a few weeks.

Impotence as a side effect varies greatly, from 25 to 50 percent in men who are under 60. Both impotence and incontinence can worsen over a period of continued treatment because healthy cells become less and less able to repair themselves. Penile shrinkage is also a risk associated with external radiation therapy. This shrinkage may also be called urethral stricture, because penile shrinkage is caused by a shrinking or the urethra. A physician, however, can "stretch" the urethra back to its normal size during an outpatient procedure. Proctitis and prostatitis are also risks of external radiation therapy. The beam may damage the rectum leading to blood or mucus in the stool.

Proctitis can be treated with laser surgery or suppositories and enemas. Prostatitis may occur in about a third of patients who receive external radiation treatment for prostate cancer. Prostatitis may cause the PSA level to rise; patients, however, should not be alarmed. A swollen prostate gland, not prostate cancer, is the cause of the rising PSA level.

Managing Side Effects

Patients often experience little or no side effects from radiation therapy and are able to continue their normal routines. However, some patients do feel some discomfort from the treatment. Be sure to talk to a member of your radiation oncology treatment team about any problems you may have.

Side effects usually begin by the second or third week of treatment, and they may last for several weeks after the final radiation treatment. In rare instances, serious side effects develop after radiation therapy is finished. Your radiation oncologist and radiation oncology nurse are the best people to advise you about the side effects you may experience. Talk with them about any side effects you are having. They can give you information about how to manage them and may prescribe medicines that can help relieve your symptoms.

The side effect most often reported by patients receiving radiation is fatigue. The fatigue patients experience is usually not very severe, and patients can often continue all or some of their normal daily activities with a reduced schedule. Many patients continue to work full time during radiation therapy.

Many patients are concerned that radiation therapy will cause another cancer. In fact, the risk of developing a second tumor because of radiation therapy is very low. For many patients, radiation therapy can cure your cancer. This benefit far outweighs the very small risk that the treatment could cause a later cancer. If you smoke, the most important thing you can do to reduce your risk of a second cancer is quit smoking.

What causes fatigue?

During radiation therapy, the body uses a lot of energy healing itself. Stress related to your illness, daily trips for treatment, and the effects of radiation on normal cells all may contribute to fatigue. Most people begin to feel tired after a few weeks of radiation therapy. Feelings of weakness or weariness will go away gradually after your treatment is finished.

You can help yourself during radiation therapy by not trying to do too much. If you feel tired, limit your activities and use your leisure time in a restful way. Do not feel that you have to do all the things you normally do. Try to get more sleep at night, and rest during the day if you can.

If you have been working a full-time job, you may want to continue. Although treatment visits are time-consuming, you can ask your doctor's office or the radiation therapy department to help by trying to schedule treatments with your workday in mind.

Some patients prefer to take a few weeks off from work while they're receiving radiation therapy; others work a reduced number of hours. You may want to speak frankly with your employer about your needs and wishes during this time. You may be able to agree on a part-time schedule, or perhaps you can do some work at home.

Whether you're going to work or not, it's a good idea to ask family members or friends to help with daily chores, shopping, child care, housework, or driving. Neighbors may be able to help by picking up groceries for you when they do their own shopping. You also could ask someone to drive you to and from your treatment visits to help conserve your energy.

How are skin problems treated?

You may notice that your skin in the treatment area may begin to look reddened, irritated, sunburned, or tanned. After a few weeks you may have very dry skin from the therapy. Ask your doctor or nurse for advice on relieving itching or discomfort. With some kinds of radiation therapy, treated skin may develop a "moist reaction," especially in areas where there are skin folds. When this happens, the skin is wet and it may become very sore. It's important to notify your doctor or nurse if your skin develops a moist reaction. They can give you some suggestions on how you can keep these areas dry.

During radiation therapy you will need to be very gentle with the skin in the treatment area. Avoid irritating treated skin. When you wash, use only lukewarm water and mild soap. Don't wear tight clothing over the area. It's important not to rub, scrub, or scratch any sensitive spots. Also avoid putting anything that is very hot or very cold, such as heating pads or ice packs, on your treated skin. Don't use any powders, creams, perfumes, deodorants, body oils, ointments, lotions, or home remedies in the treatment area while you're being treated or for several weeks afterward (unless approved by your doctor or nurse). Many skin products can leave a coating on the skin that can interfere with radiation therapy or healing.

Avoid exposing the area to the sun during treatment and for at least I year after your treatment is completed. If you expect to be in the sun for more than a few minutes you will need to be very careful. Wear protective clothing (such as a hat with a broad brim and a shirt with long sleeves) and use a sunscreen. Ask your doctor or nurse about using sunblocking lotions.

The majority of skin reactions to radiation therapy should go away a few weeks after treatment is finished. In some cases, though, the treated skin will remain darker than it was before.

Managing Nausea

Some patients report feeling queasy for a few hours right after radiation therapy to the stomach or abdomen. If you have this problem, do not eat for several hours before your treatment time. You may be able to handle the treatment better on an empty stomach. After your treatment, you may find it helpful to wait 1 to 2 hours before eating again. If the problem persists, ask your doctor to prescribe a medicine (an antiemetic) to prevent nausea. If antiemetics are prescribed, try to take them when your doctor suggests, even if you sometimes feel that they are not needed.

If your stomach feels upset just before your treatment, try a bland snack such as toast or crackers and apple juice before your appointment. This type of side effect may be related to your emotions and concerns about treatment. Try to unwind a bit before you have your treatment. If you have to spend time in a waiting room, reading a book, writing letters, or working a crossword puzzle may help you relax.

Here are some tips to help an unsettled stomach:

Stick to any special diet that your doctor or dietitian gives you.

Eat small meals.

Eat often and try to eat and drink slowly.

Avoid foods that are fried or are high in fat.

Drink cool liquids between meals.

Eat foods that have only a mild aroma and those that can be served cool or at room temperature.

For a severe upset stomach, try a clear liquid diet (broth and juices) or bland foods that are easy to digest, such as dry toast and gelatin.

Managing Diarrhea

Diarrhea most often begins in the third or fourth week of radiation therapy. Your doctor may suggest you change your diet, prescribe medicine for you, or give you special instructions to help with the problem. Tell the doctor or nurse if these changes are not controlling your diarrhea.

The following changes in your diet also may help:

Try a clear liquid diet (water, weak tea, apple juice, clear broth, plain gelatin) as soon as diarrhea starts or when you feel that it's going to start.

Ask your doctor or nurse to advise you about liquids that won't make your diarrhea worse. Apple juice, peach nectar, weak tea, and clear broth are frequent suggestions.

Avoid foods that are high in fiber or can cause cramps or a gassy feeling such as raw fruits and vegetables, coffee, beans, cabbage, whole grain breads and cereals, sweets, and spicy foods.

Eat frequent small meals.

Avoid milk and milk products if they irritate your bowels.

When the diarrhea starts to improve, try eating small amounts of low-fiber foods such as rice, bananas, applesauce, mashed potatoes, low-fat cottage cheese, and dry toast.

Be sure your diet includes foods that are high in potassium (bananas, potatoes, apricots), an important mineral that you may lose through diarrhea.

Diet planning is a very important part of radiation treatment of the stomach and abdomen. Keep in mind that these problems will be reduced greatly when treatment is over. In the meantime, try to pack the highest possible food value into even small meals so that you will have enough calories and vital nutrients.

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