Possible Side Effects of Radiation Treatment for Prostate Cancer

The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.

You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.

Short Term Side Effects

Patients who receive any type of radiation therapy (external beam or brachytherapy) to treat their prostate cancer can have side effects. “Short term” side effects are ones that start during or shortly after your radiation treatment. Below is a list of possible short term side effects. Treatments can affect each patient differently, and you may not have these particular side effects. Talk with your care team about what you can expect from your treatment

• Skin irritation in the treatment area is common. It may become red, irritated, dry, or sensitive. This may start to look like a sunburn. Treat the skin gently to avoid further irritation, and bathe carefully, using only warm water and mild soap. Do not use scented lotions or soaps, as these may cause more irritation.
• Fatigue is very common with radiation treatment and tends to begin a few weeks into therapy. Fatigue often goes away slowly over the weeks and months after treatment.
• Irritation to the rectal and urinary tract tissue can cause changes to your bowel and urine habits. It can cause urinary urgency, urinary frequency, nocturia (waking up at night to go to the bathroom), diarrhea, incontinence, or pain with bowel movements or urination (dysuria). These symptoms tend to resolve within a few weeks of finishing treatment. Drink plenty of fluids. Talk to your provider about ways to manage these symptoms. In some patients, these problems can last after treatment.
• Loss of hair in the pelvic area. Hair typically starts to regrow a month or so after treatment. However, your hair might not grow back exactly as it was before treatment and for some, the hair may not ever grow back.
• Reduced blood counts, including neutropenia, anemia, or thrombocytopenia (low platelet count).

Late Effects

Late effects can happen months to years after cancer treatment has ended. The risk of late effects depends on the areas included in the field of radiation and the radiation techniques that were used. Some of the potential late effects of radiation to the prostate include:

• Most men will be sterile after radiation treatment for prostate cancer. Talk to your oncology team about sperm banking if you wish to have a child in the future. 
• Erectile dysfunction or dry orgasm can occur after radiation therapy. For some men, medications or other treatments can help. A couple’s therapist can also help you and your partner cope with these changes in your relationship.
• Bladder problems, like incontinence (not being able to hold your urine in), hemorrhagic cystitis (causes blood in the urine), urinary tract infections, and bladder cancer may happen. If you notice any changes in your bathroom habits or urine, contact your provider.
• Gastrointestinal (stomach and bowel) problems can include strictures, blood in the stool, chronic diarrhea, and colon cancer.
• There is a low risk of developing a second cancer in or near the radiation field. These are called secondary cancers, and they happen because of the exposure of healthy tissue to radiation. Modern radiation techniques are designed to limit this exposure.
• Lymphedema, which is swelling, can occur if the lymph nodes have been damaged. If you notice any new swelling in your groin, legs, or feet, call your provider right away. 
• You might have permanent skin changes in the area that was exposed to radiation. 

You may not have any side effects or late effects of radiation treatment. But if you do, it is important that you speak to your provider about how to best manage these side effects. After treatment, talk with your oncology team about receiving a survivorship care plan, which can help you manage the transition to survivorship and learn about life after cancer.