Prostate cancer: Understanding late effects of radiotherapy
Late side effects from external beam radiotherapy may happen a few months or years after treatment. They might happen once, carry on over the long term or come and go. Sometimes they cannot be cured, but it might be possible to manage them.
You might have late effects not listed here, because everyone is different. They may also be caused by a different part of your cancer treatment. It is not possible to predict if you will get them and when they might happen, which can be difficult to come to terms with. Research and support for late effects of radiotherapy is growing.
Joining a support group can be a positive way to share your experiences, feel less alone, and come to terms with the physical and emotional impact of treatment. Ask your clinical team if you need more support or have any late effects at all.
This page looks at late side effects.
How likely am I to get late side effects?
Before treatment you will discuss and sign a consent form with your clinical oncologist or therapeutic radiographer. They will tell you what to expect, and you can ask questions and discuss any concerns you have about late effects. It’s important to know what you are consenting to and can help to take someone with you.
You can read different radiotherapy consent forms (HERE) based on the specific area being treated. These consent forms are packed with useful information about early and late side effects.(1)
When you consent to treatment, you are saying you understand that you have a chance of getting late side effects. Your team will use words like Expected, Common, Less Common and Rare.
This table shows what these words mean.
| Wording on the consent form | % chance of side or late effect | How many patients will get this? |
|---|---|---|
| Expected | 50 to 100% | Between half and all patients |
| Common | 10 to 50% | Up to half of all patients |
| Less common | Less than 10% | Fewer than one in ten patients |
| Rare | Less than 1% | Fewer than one in 100 patients |
Key information: It’s important to let your consultant know as soon as possible if you plan to have children. They can guide you on the best options.
Possible late side effects
- Effects on the bladder: You might need to wee quickly (urgency) and need to wee more often (frequency). You might get times when it stings or burns when you wee (cystitis). You may not be able to empty your bladder completely. Less commonly bleeding may occur that you can see when you wee. Rare effects are bladder damage which may require surgery – due to perforation (hole), fistula (abnormal hole between two parts of your body) and incontinence.
- Urethra scarring: scarring in the urethra (the tube that connects your bladder to where wee comes out). This scarring can make it harder to wee and can require surgery.
- Effects on the bowels: Radiotherapy can cause changes in your bowel habits, like producing more mucus, needing to poo more often or quickly and loose watery poo. Less commonly some bleeding can occur and inflammation of the rectum. These bowel problems, including fistula, affect daily life in less than 5% of people. This can make receiving penetrative anal sex difficult.
- Sexual function: Over time, radiotherapy can make it harder to get and keep erections, especially if you are also on hormone treatments or had issues before treatment. About half of people who had normal erections before treatment might see changes in their ability to have erections after treatment. You may have dry ejaculations, see a change in the length of your penis and how it looks or find that giving and receiving penetrative sex becomes more difficult.
- Fertility: Most people will have reduced fertility after radiation therapy, but you can store sperm before treatment if you plan to have children later.
- Cancer-related fatigue: You might find you still have fatigue after your treatment has finished. For some people this can go on for months or years.
Rare late effects
- Incontinence: It’s very rare to have trouble controlling your bladder after radiotherapy alone, it’s more common if you’ve had surgery too.
- Bone damage: There is the potential pelvis/hip bone thinning and/or fractures can occur but this is rare.
- Radiotherapy including pelvic lymph nodes: Lymphoedema (swelling in your legs), malabsorption (unable to a absorb nutrients) and Neuropathy (nerve damage in legs causing pain and weakness) are all rare effects.
- Second Cancer: There is a very small chance that you could develop another type of cancer. This is rare, and depends on lots of different factors like age, area treated and radiation dose.
What can help with these late effects?
- Bladder or rectal bleeding: If you have bleeding from the bladder or rectum that doesn’t go away, doctors can use a laser to seal the bleeding blood vessels. This is very effective for rectal bleeding.
- Medication: There are several medications that can help with bladder problems such as Tamsulosin, Mirabegron, Solifenacin.
- Pelvic floor exercises: Pelvic floor muscle exercises help strengthen the muscles that help control when you wee and poo. They also help with erectile function.
- Bowel health: Professional advice on what food and drink to have can help. So can medication. Speak to your treatment team about any bowel changes and watch for any signs of blockage.
- Urethra scarring: A urologist can stretch the scarred area in the urethra to help with a weak wee stream.
- Erections: There are medicines, injections, lifestyle changes, vacuum pumps and surgeries that can help with erections. Talk to your clinical team about these options.
- Monitoring rare side effects: Talk to your clinical team as soon as you notice any changes, this can help catch and treat any serious problems early.
- Managing cancer-related fatigue: Food and drink, keeping active, keeping a fatigue diary, medicine like steroids and physiotherapy may all be options for managing fatigue. Speak to your doctor or medical team for advice; and learn more about managing cancer-related fatigue.
- Drinking fluids: Drinking plenty of fluids such as water and squash can help with fatigue and tiredness caused by your treatment. You can try diluted juice if you don’t like water.
- Skin care: The skin in the treatment area will always be more sensitive to the sun. Always protect it by covering up and use a high factor sunblock.
- Keeping active: Gentle movement can help you feel better, both during and after treatment. Your clinical team can tell you what is safe for you to do.
- Alcohol use: Please follow the NHS guidelines on safe drinking levels and any instructions you get from your team on what is right for you, your diagnosis and your treatment. If in doubt, please ask your team.
- Stop smoking: If you are looking to stop or reduce smoking, there are services available to help you.
Always talk to your doctor or clinical team about any late effects you have: even if they are not mentioned here. Everyone is different and experiences treatment differently. There may be ways they can help you reduce or manage symptoms.
Further information
Prostate cancer resources and support:
Support for patients and families • Radiotherapy UK
