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Radiotherapy for advanced prostate cancer

This fact sheet is for men with prostate cancer that has spread from the prostate to other parts of the body (advanced prostate cancer). Your partner, family or friends might also find it helpful.

We look at radiotherapy to relieve pain and other symptoms – sometimes called palliative radiotherapy. Palliative radiotherapy doesn’t aim to cure cancer but it can help to slow down its growth. We describe the different types of palliative radiotherapy and the possible side effects.

This fact sheet doesn’t talk about radiotherapy used in localised or locally advanced prostate cancer. We look at this in our fact sheets, External beam radiotherapy, Permanent seed brachytherapy and High dose-rate brachytherapy.

Each hospital will do things slightly differently. Use this information as a general guide and ask your doctor, radiographer or nurse for

more details. You can also speak to our Specialist Nurses, in confidence, on 0800 074 8383.

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Who can have this type of radiotherapy?If you have advanced (metastatic) prostate cancer you may be offered radiotherapy to slow down the growth of the cancer and control symptoms, such as bone pain.

Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body, such as the bones. Treatments for advanced prostate cancer, such as hormone therapy, can keep it under control for many months or years. You can read more about advanced prostate cancer, diagnosis and treatments in our fact sheet, Advanced prostate cancer.

In this fact sheet:• Who can have this type of radiotherapy?

• How does radiotherapy treat advanced prostate cancer?

• What are the advantages and disadvantages of radiotherapy?

• External beam radiotherapy (EBRT)

• Radioisotope treatment

• What happens after radiotherapy?

• Dealing with prostate cancer

• Questions to ask your doctor, radiographer or nurse

• More information

• About us

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Prostate cancer can spread to any part of the body, but the most common places for it to spread to are your bones or lymph nodes.

You might hear cancer that has spread to the bones described as bone secondaries, bone metastases or bone mets. This isn’t the same as bone cancer, which starts in the bones.When prostate cancer spreads to your bones it can cause pain and may sometimes make moving around more difficult. Radiotherapy can help treat this pain. Some men with prostate cancer have other symptoms, such as blood in their urine or discomfort from swollen lymph nodes. Radiotherapy can often help with these symptoms too.

Radiotherapy can also be used to treat a condition called metastatic spinal cord compression (MSCC). See page 4.

There are other treatments to help control the symptoms of advanced prostate cancer, including:• pain-relieving drugs, which can be used alone

or in combination with other treatments • treatments for the cancer itself, such as

hormone therapy or chemotherapy • drugs called bisphosphonates, which

help relieve bone pain• steroids to reduce swelling around the

cancer and relieve pain.

Talk to your doctor or nurse about which treatment might be right for you. This could depend on where your cancer has spread to, what treatment you’ve already had, and your general health and fitness.

Read more about ways of relieving pain and symptoms of advanced prostate cancer in our booklet, Advanced prostate cancer: Managing symptoms and getting support. You can also speak to our Specialist Nurses.

How does radiotherapy treat advanced prostate cancer? The aim of all types of radiotherapy is to destroy cancer cells.

Radiotherapy damages cells and stops them from dividing and growing. Cancer cells can’t recover from this damage so they die, but healthy cells can repair themselves more easily.

For advanced prostate cancer, the main aims of radiotherapy are:• to shrink the cancer in the part of the body

being treated – to stop it pressing on the nerves and causing pain

• to slow the growth of the cancer, giving your bones time to repair and strengthen.

There are two types of radiotherapy that can do this:• external beam radiotherapy (EBRT)• a type of internal radiotherapy called

radioisotope treatment.

Radiotherapy for advanced prostate cancer uses less radiation overall than radiotherapy for earlier stages of prostate cancer. The course of treatment is also often shorter.

What are the advantages and disadvantages of radiotherapy?The advantages and disadvantages of radiotherapy depend on your general health, previous treatment and how far your cancer has spread. Talk to your doctor, radiographer or nurse about your own situation.

Advantages• Radiotherapy may help relieve your

symptoms for several months and improve day-to-day life.

• It may slow down the growth of the cancer in the area that’s treated and help make your bones stronger.

• Treatment works quite quickly. You should have some pain relief within a few weeks.

• You might be able to reduce the dose of any pain-relieving drugs you’re taking. This could be useful if they are causing side effects.

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• Research has shown that a new type of internal radiotherapy called radium -223 can help relieve symptoms and can help men with advanced prostate cancer to live longer (see page 6).

Disadvantages• Like most treatments, radiotherapy can cause

side effects. The risk of side effects depends on which type of radiotherapy you have.

• You might have slightly more pain during treatment, and for a few days afterwards. This should soon improve.

• The pain can come back after several months. If this happens, you might need further treatment with radiotherapy or other treatments.

The specialist who plans your radiotherapy treatment with you is called a clinical oncologist. They should talk to you about whether you might benefit from radiotherapy, which type of radiotherapy you will have, how long the treatment could take and the possible side effects. A specialist called a therapeutic radiographer will give you your treatment.

External beam radiotherapy (EBRT)External beam radiotherapy is an effective and common way of relieving pain from prostate cancer that has spread to your bones. During

treatment, high-energy X-ray beams are directed at the area of pain from outside the body.

It may be a week or more after treatment before your pain starts to improve. It normally takes a few weeks for treatment to have its full effect. Pain relief usually lasts for an average of four to six months, but this can vary from person to person. For every ten men who have this treatment, between five and eight men (50 to 80 per cent) get some pain relief from it.

Preparing for treatmentBefore starting treatment you will usually have a planning session. This might involve a CT

(computerised tomography) scan to help your doctor, radiographer or nurse map the exact area of your body that needs treating.

A few very small permanent marks, like tiny tattoos, will be made on your skin in the area to be treated. This helps the radiographers put you in the right position during treatment.

What does treatment involve?You will have your treatment in the outpatient radiotherapy department at the hospital. This means you’ll usually be able to go home the same day.

You’ll have either one single dose or a series of smaller doses spread out over a week or more. If you’re having more than one dose, you might have it every day, every few days or once a week. At the beginning of each treatment, the radiographers will help move you into the right position on the treatment couch. They will use the marks that were made on your body as a guide.

The radiographers will then leave the room, but they’ll be able to see you at all times through cameras. The radiotherapy machine moves around your body and it will make a slight noise. It doesn’t touch you and you won’t feel anything – a bit like having an X-ray. You’ll need to lie still, but the treatment only lasts a few minutes. You should be able to go home after the treatment has finished.

What are the side effects?Like all treatments, external beam radiotherapy causes side effects in some men. But they affect each man differently and you might not get all of them, or any of them. Ask your doctor, radiographer or nurse for more information on the risk of side effects.

There are usually only a few side effects from external beam radiotherapy because you’ll only have a few doses of treatment. The risk of side effects is higher if you are having radiotherapy to several different areas of your body or if a higher total amount of radiotherapy is used.

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Which side effects you have will depend on which part of your body is treated. These are some of the most common side effects of external beam radiotherapy.

• Some men feel tired for a week or two after treatment finishes.

• Your skin might get darker and itch in the area treated, similar to sunburn. Avoid using any creams, lotions or perfumed soaps unless you are advised to do so by your doctor, radiographer or nurse.

• Radiotherapy to your pelvis or abdomen (stomach area) can make you feel or be sick – anti-sickness medication can help treat this.

• Radiotherapy to your lower body can lead to loose and watery bowel movements (diarrhoea) – there are treatments to help this.

• You might have slightly more pain during the course of treatment or for a few days after it has finished – this should soon get better. It is important to keep taking any pain-relieving drugs you’ve been given.

Metastatic spinal cord compression (MSCC)Prostate cancer cells can spread to the bones of the spine (vertebrae). This can lead to a complication called metastatic spinal cord compression (MSCC) where the cancer cells press on the spinal cord.

MSCC is not common, but you need to be aware of it if you have prostate cancer that has spread to your bones or has a high risk of spreading to your bones. The risk of MSCC is highest if your cancer has already spread to the spine. Speak to your doctor or nurse for more information about your risk. MSCC can cause any of the following symptoms.

• Pain or soreness in your lower, middle or upper back or neck that is severe or different from usual pain. The pain might get worse when you cough, sneeze, lift or strain, or go to the toilet. It might get worse when you are lying down. It may wake you at night or stop you from sleeping.

• A narrow band of pain around your tummy or chest which can move towards your lower back, buttocks or legs.

• Pain that moves down your arms or legs.

• Weakness in your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.

• Numbness or tingling (pins and needles) in your legs, arms, fingers, toes, buttocks, stomach area or chest, that doesn’t go away.

• Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

These symptoms can also be caused by other conditions, but it’s still important to get medical advice immediately if you think you might have MSCC. It is a serious condition and the sooner you have treatment, the lower your risk of long-term problems. If you don’t have details of who to contact, or you can’t reach them, go to your nearest accident and emergency (A&E) department.

If you are having radiotherapy to treat MSCC you will need treatment quite quickly. This means that you will only have a short time to discuss your treatment with your doctor, and the planning session will take place just before you have your treatment. Ask your doctor, radiographer or nurse if you have any questions before your treatment starts.

Read more about MSCC in our fact sheet, Metastatic spinal cord compression (MSCC).

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• Radiotherapy can affect the amount of blood cells your body produces, which can lead to anaemia or mean you’re more likely to bruise easily, bleed or get an infection. This is more likely if a large area of your body is being treated.

Radioisotope treatment Another way of using radiotherapy to treat advanced prostate cancer is with an injection of a very small amount of a radioactive liquid called a radioisotope. You may also hear this called internal radiotherapy.

The treatment works by travelling around the body in your blood and collecting in any bones that have been damaged by prostate cancer.

Radioisotopes can be particularly helpful if you have pain in more than one area. For every ten men who have this treatment, between six and seven men (60 to 70 per cent) get some pain relief from it.

Strontium-89Strontium-89 (Metastron®) is a radioisotope that can be used to relieve bone pain and prevent new pain from occurring. It can take up to two weeks to start working and lasts for around 4 to 15 months.

Preparing for treatmentBefore having strontium-89 there are things you should discuss with your doctor, radiographer or nurse.

• Let them know if you are taking any medicines. Strontium-89 can affect the way your blood clots so you may need to stop taking anti-inflammatory drugs such as ibuprofen, or blood-thinning drugs such as aspirin or warfarin.

• If you are taking calcium, phosphate or vitamin D supplements, you may need to stop taking them for a while.

• You might not be able to have treatment with strontium-89 if your cancer or previous treatment has damaged your bone marrow.

Bone marrow is the spongy tissue found inside some of your larger bones – it’s where blood cells are made.

If you have strontium-89, you may not be able to have chemotherapy in the future if your pain returns. This is because both chemotherapy and strontium-89 can affect your bone marrow. Speak to your doctor about whether chemotherapy is an option for you. If it isn’t, there will usually be another treatment you can have.

What does treatment involve?You’ll have the treatment at a hospital outpatient appointment and will be able to go home afterwards. On the day of your appointment you will be given strontium-89 through a small tube (cannula) put into a vein in your arm or hand. This will only take a couple of minutes.

After the injection, your urine and blood will be slightly radioactive. It will be safe for you to be around other people, including children. But your doctor, radiographer or nurse will let you know what safety guidelines you need to follow for a few days after treatment. For example, you may need to be extra careful with wiping up any spills after going to the toilet and flushing tissues away.

Strontium-89 will stay in the bones for several months and continue to treat the cancer cells. Any strontium-89 that is not taken up by the bones will be gone from your urine and blood in a few days.

What are the side effects?Most side effects of strontium-89 only last a short time and are not severe.

• Some men have more pain in the days after treatment, but this should only last for a few days.

• Sometimes the bone marrow is affected, which might change the way your blood clots and increase your risk of infection and anaemia. If this happens you may get a fever, chills, bruising, bleeding or tiredness. It is rare for infection or anaemia to be severe, but you might need regular blood tests after treatment.

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• You may feel or be sick (nausea or vomiting) or have diarrhoea. This is not common.

Radium-223Radium-223 (Xofigo®) is a new type of radioisotope for men whose prostate cancer has stopped responding to hormone therapy. It can delay some of the symptoms of advanced cancer, such as bone fractures, and can reduce bone pain. It may also help men live longer.

Radium-223 may be an option if your prostate cancer has spread to your bones but not to other organs in your body, such as your liver. It’s available in the UK for men who have already had hormone therapy and the chemotherapy drug docetaxel.

If you haven’t yet had chemotherapy, radium-223 is only routinely available on the NHS if you live in Scotland. If you live in England, Wales or Northern Ireland, radium-223 isn’t widely available before chemotherapy – but your doctor may be able to apply for you to have it.

You may also be able to get radium-223 through a clinical trial.

Speak to your doctor or nurse about whether radium-223 might be an option for you. You can also speak to our Specialist Nurses or visit our website at prostatecanceruk.org/new-treatments

Preparing for treatmentBefore having radium-223 there are things you should discuss with your doctor, radiographer or nurse.

• Let them know if you are taking any medicines. If you take calcium, phosphate or vitamin D supplements, you may need to stop taking these for a while.

• Your doctor or nurse may ask you to have a blood test before treatment to check your blood cell levels are high enough.

What does treatment involve?Radium-223 is injected into a vein through a small tube put into your arm (cannula). This will only take a couple of minutes. You should be able to go home straight after the treatment. You will normally have an injection every four weeks, for up to six injections.

After your injection, your urine, bowel movements and blood will be slightly radioactive. It will be safe for you to be around other people, including children. But your doctor, radiographer or nurse will let you know what safety guidelines you need to follow for a week (seven days) after treatment. For example, you may need to be extra careful with wiping up any spills after going to the toilet and flushing tissues away.

What are the side effects?Radium-223 does not cause much damage to the surrounding healthy cells, so it doesn’t usually cause side effects. Because radium-223 works in a slightly different way to other radioisotopes you are less likely to get side effects.

If you do get side effects they may include feeling or being sick (nausea or vomiting) and diarrhoea. Radium-223 can affect your bone marrow, which means you may have a drop in blood cells. But this is rarely severe enough to cause problems.

What happens after radiotherapy?Your doctor will monitor you and your symptoms. Pain can sometimes get worse during treatment and for a few days afterwards – this is called a pain flare. If you get this, it shouldn’t last long. Your doctor might prescribe some pain-relieving drugs to help with the pain, or increase the dose that you already take.

You should notice that the pain gradually improves, though it might take a few weeks for the treatment to be most effective. The pain relief usually lasts for several months and you may be able to reduce the dose of any pain-relieving drugs you are taking. But speak to your doctor, nurse or GP about this – you shouldn’t reduce the dose suddenly.

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If your pain or other symptoms don’t improve, talk to your doctor or nurse. If your pain comes back, they might suggest another course of radiotherapy. If you’ve already had external beam radiotherapy to one area, you may be able to have it again to the same area. This will depend on the dose you’ve already had.

If you have bone pain in more than one new area, you might be able to have more external beam radiotherapy or internal radiotherapy. You might be able to have more than one course of internal radiotherapy.

There are other treatments that might help reduce or control any symptoms. The options available to you will depend on treatments you’ve already had and might include:• treatments for the cancer itself, such as

hormone therapy or chemotherapy • drugs called bisphosphonates, which help

relieve bone pain• steroids to reduce swelling around the cancer

and relieve pain.

Ask your doctor or nurse about your options.

Read more in our fact sheet, Managing pain in advanced prostate cancer, or speak to our Specialist Nurses.

Dealing with prostate cancerIf you’re dealing with prostate cancer you may feel scared, stressed or even angry. There is no ‘right’ way to feel and everyone reacts differently. There are things you can do to help yourself and people who can help.

How can I help myself?Find out about your treatment, so you know what your options are and what to expect.

If you have advanced prostate cancer you might feel tired and find it harder to keep active. Adapt your normal hobbies and activities or find new ways of enjoying yourself. Don’t push yourself, and rest if you feel you need to.

Find someone you can talk to. This could be someone close or a counsellor. Read more in our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues.

Who can help?Your medical teamSpeak to your nurse, doctor, GP or anyone in your medical team. They can explain your diagnosis, treatment and side effects, listen to your concerns, and put you in touch with others who can help.

Our Specialist NursesOur Specialist Nurses can answer your questions and explain your diagnosis and treatment options. They’ve got time to listen, in confidence, to any concerns you or those close to you have.

Your palliative care team or a hospiceYou may be able to get support from your community palliative care team or local hospice. These teams don’t just provide care for those at the end of life. They provide a range of services including treatment to manage symptoms, such as pain. They can also offer emotional and spiritual support, practical and financial advice and support for families.

Some hospices provide day centres with services such as complementary therapy. Or you might be able to stay at the hospice for a short time while they get your pain under control. The community palliative care team can usually come and visit you at home if you prefer.

Your GP, doctor or nurse at the hospital, or district nurse can refer you to a hospice service or community palliative care team. They will continue to work closely with these teams to support you. You can find out more about these services from Hospice UK, Macmillan Cancer Support and Marie Curie.

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I contacted my community palliative care team and would recommend getting their help. They’ve been a great support in many aspects of living with prostate cancer and have given me expert advice on pain relief.A personal experience

Trained counsellorsMany hospitals have specialist counsellors for people with cancer – ask your doctor or nurse at the hospital if this is available. Your GP can also refer you, or you can see a private counsellor.

Our one-to-one support serviceOur one-to-one support service is a chance to speak to someone who’s been there. They can share their experiences and listen to yours. You can discuss whatever’s important to you.

Our online communityOur online community is a place to deal with prostate cancer together. You can talk about whatever’s on your mind. Anyone can ask a question or share an experience.

Local support groups At local support groups, men get together to share their experiences of prostate cancer. You can ask questions, share worries or talk about what you are going through. Many groups also welcome friends and family.

Our fatigue support serviceOur fatigue support service is a 10-week telephone service delivered by our Specialist Nurses. It can help if you have problems with extreme tiredness (fatigue), which is a common symptom of prostate cancer. Fatigue can also be a side effect of some treatments for prostate cancer. The fatigue support service can help you make positive changes to your behaviour and lifestyle, which can improve your fatigue over time.

To find out more about any of the above, visit prostatecanceruk.org/get-support or call our Specialist Nurses on 0800 074 8383.

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How will radiotherapy help me and how long will the pain relief last?

What other treatments are available to help with my pain?

Which type of radiotherapy is best for me?

Will I get any side effects? What can help with these?

Are there any safety guidelines I should follow during and after treatment?

Who should I contact if I have any questions at any point during my treatment? How do I contact them?

Will having this treatment mean I can’t have other types of treatment later on (for example, chemotherapy)?

Questions to ask your doctor or nurseYou may find it helpful to keep a note of any questions you have to take to your next appointment.

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More informationBritish Association for Counselling & Psychotherapywww.itsgoodtotalk.org.uk Telephone: 01455 88 33 00Information about counselling and details of therapists in your area.

Cancer Research UKwww.cancerresearchuk.orgTelephone: 0808 800 4040Patient information from Cancer Research UK.

Healthtalk.orgwww.healthtalk.orgWatch, listen to and read personal experiences of men with prostate cancer and other health problems.

Hospice UKwww.hospiceuk.orgTelephone: 020 7520 8200Information about hospice care, including a database of hospice and palliative care providers.

Macmillan Cancer Supportwww.macmillan.org.ukTelephone: 0808 808 0000Practical, financial and emotional support for people with cancer, their family and friends.

Maggie’s Centreswww.maggiescentres.org Telephone: 0300 123 1801Drop-in centres for cancer information and support. Includes an online support group.

Marie Curiewww.mariecurie.org.ukTelephone: 0800 090 2309Runs hospices throughout the UK and a nursing service for people in their own home free of charge.

NHS Choiceswww.nhs.ukInformation about treatments, conditions and lifestyle. Support for carers and a directory of health services in England.

Pain Association Scotland www.painassociation.comTelephone: 0800 783 6059 Runs groups in Scotland that help people manage their pain and improve their coping skills.

Pain Concernwww.painconcern.org.ukTelephone: 0300 123 0789 Information and support for people with pain and those who care for them.

Penny Brohn Cancer Carewww.pennybrohncancercare.orgTelephone: 0845 123 23 10 Runs courses and offers physical, emotional and spiritual support for people with cancer and those close to them.

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About usProstate Cancer UK fights to help more men survive prostate cancer and enjoy a better life.

This fact sheet is part of the Tool Kit. You can order more Tool Kit fact sheets, including an A to Z of medical words, which explains some of the words and phrases used in this fact sheet.

Download and order our fact sheets and booklets from our website at prostatecanceruk.org/publications or call us on 0800 074 8383.

At Prostate Cancer UK, we take great care to provide up-to-date, unbiased and accurate facts about prostate cancer. We hope these will add to the medical advice you have had and help you to make decisions. Our services are not intended to replace advice from your doctor.

References to sources of information used in the production of this fact sheet are available at prostatecanceruk.org

This publication was written and edited by: our Health Information team

It was reviewed by:• Philip Reynolds, Advanced Practice

Radiographer (Urology), Guy’s and St Thomas’ NHS Foundation Trust

• Alastair Thomson, Consultant Clinical Oncologist, Royal Cornwall Hospital, Truro

• Deborah Victor, Uro-oncology Clinical Nurse Specialist, Royal Cornwall Hospitals NHS Trust

• Our Volunteers• Our Specialist Nurses

Speak to our Specialist Nurses0800 074 8383*prostatecanceruk.org

Donate today – help others like youDid you find this information useful? Would you like to help others in your situation access the facts they need? Every year, 40,000 men face a prostate cancer diagnosis. Thanks to our generous supporters, we offer information free to all who need it. If you would like to help us continue this service, please consider making a donation. Your gift could fund the following services:

• £10 could buy a Tool Kit – a set of fact sheets, tailored to the needs of each man with vital information on diagnosis, treatment and lifestyle.

• £25 could give a man diagnosed with a prostate problem unlimited time to talk over treatment options with one of our Specialist Nurses.

To make a donation of any amount, please call us on 0800 082 1616, visit prostatecanceruk.org/donate or text PROSTATE to 70004*. There are many other ways to support us. For more details please visit prostatecanceruk.org/get-involved

*You can donate up to £10 via SMS and we will receive 100% of your donation. Texts are charged at your standard rate. For full terms and conditions and more information, please visit prostatecanceruk.org/terms

© Prostate Cancer UK July 2015To be reviewed July 2017

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