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Prostate Cancer

External beam radiotherapy

External beam radiotherapy is used both to treat cancer and to relieve pain when the cancer has spread to the bones (see 'Pain relief'). It can also be used together with other therapies such as hormone therapy. Here we discuss men's experience of radiotherapy as a treatment for prostate cancer.

Radiotherapy as a means of cure is usually given five days a week, for over 4-7 weeks. Some of the men who opted for radiotherapy described their experiences in the waiting room at the hospital while waiting for a diagnosis, and for treatment.

 

Comments that his only inconvenience was radiotherapy required so much time.

Comments that his only inconvenience was radiotherapy required so much time.

Age at interview: 70
Sex: Male
Age at diagnosis: 67
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The process of radiotherapy... the only inconvenient part of the radiotherapy treatment is you've just got to cut out 6' weeks of your calendar because you've got to report to the hospital Monday to Friday for 6 weeks and then for some reason or other another 3 days, so it ties you in terms of what you can do. But as far as the hospital was concerned you get an appointment, you get a time and I found that you were always taken within 10 to 15 minutes of your time. You went in for the radiotherapy, you were out and that was it, so the actual time spent in the treatment room was probably 20 minutes to half an hour at the most.
 
 

Expresses his frustration with the worry caused by delay in the waiting room.

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Expresses his frustration with the worry caused by delay in the waiting room.

Age at interview: 65
Sex: Male
Age at diagnosis: 63
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The delays to see the consultant bothered me, I suppose also the delays in the waiting room bothered me, particularly when you're going for the results of a biopsy and you're there biting fingernails. Because we all feel this you know the word cancer scares the life out of us and you're waiting there for a half past 9 appointment and you see the specialist at quarter to 11 and I've seen them as late as 12 o clock. And all that time you're a bit frustrated with the long delay and you are sort of beginning to worry and worry and worry, well I say you, I'm speaking for my own self because some of us worry more than others. I feel quite anxious those times, what happens I do not know.

It must be awful.

Yes it bothers you because you almost regard this man as God who's going to pronounce a life or death sentence on you when you don't know. So to wait a long time for that sort of pronouncement does get you up a little bit tight. But the frustration as I say of waiting and the worry of what the guy is going to say to you when you go in.
 

 

Explains how efficient he found the treatment.

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Explains how efficient he found the treatment.

Age at interview: 68
Sex: Male
Age at diagnosis: 67
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We even got to know the other patients. And because I'm a councillor I took my councillor papers there so I was a bit introverted as regards all the others but because the others only had the usual 1948 magazines on the table you know I mean they built up a chat show between them and discussed everything from the weather to the latest political situation you know that was, it was good for them, they were never on their own and of course they were always together as it were you see. So all that was very harmonious and very nice and very quick and very efficient and I couldn't find a fault with that in any way whatsoever. And I bought them a box of chocolates when we left because it was rather, they were really good, they were a nice team.
 

Some described delays and frustration, while for others clinics ran more smoothly. All reported that the radiotherapy treatment itself was well managed, and painless. 

Conformal radiotherapy and IMRT

There are two common types of external beam radiotherapy:

  • 3-dimensional conformal radiotherapy (3D-CRT), and
  • intensity modulated radiotherapy (IMRT).

In 3D- CRT a computed tomography scan (CT scan) of the prostate produces an image, which is fed into a computer. This produces a 3D image of the prostate and the radioactive beams can then be emitted through a special fitment added to the radiotherapy machine which carefully shapes the radiation beams to the exact size and shape of the prostate gland, thus reducing damage to the surrounding normal tissue and organs. This reduces the side effects of radiotherapy treatment and can allow higher doses to be given, which may be more effective.

IMRT is a more complex type of  CRT and allows the radiotherapist to vary the dose of radiation given to different parts of the tumour and surrounding tissue. It is not yet known whether IMRT is better than CRT.

 

Describes the process and considers that the treatment is painless.

Describes the process and considers that the treatment is painless.

Age at interview: 61
Sex: Male
Age at diagnosis: 61
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I had to go down a week before the actual treatment and they give you what they call tattoos, it's just to save you time when you go and actually start the treatment. You're just given a little pin prick when they line the machine up, you get a tattoo that's with you for the rest of your life. In the case of prostate cancer one on your right hip, one on the left hip and then one just down below the navel. It's just a little dye that they implant into your skin so when you go for your treatment you actually lie on the table and the machine is all calibrated for the measurements, to save them having to line it up every time you go down. It's fed into a computer, you lie on the bed, you're strapped by your feet and you are then zapped on your right hip, your left hip and then directly on the front. It lasts about 3 to 5 minutes and I had to have this Monday to Friday for 20 sessions. The actual treatment you don't feel a thing.

 

Explains that the operation is very technical and precise.

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Explains that the operation is very technical and precise.

Age at interview: 65
Sex: Male
Age at diagnosis: 63
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The actual radiotherapy you just lay down, the beam is focussed and they're very precise, they mark you up with an infrared beam as it were, I'm not sure that it's infrared but at least it's a red beam, if it's infrared it would be producing heat. But they mark you up with the beam, they set you in exactly the position, they keep you very still for a period of about 2 minutes and then the radiation takes place in 3 positions. The 3 positions for the prostate to the left hand side, exactly over the middle, just up above the penis, about 3 inches up above the penis and to the right hand side. So it's quite a precise art as it were. The duration is for about 2 minutes and the only thing you do is lay there rather bored and I count the clicks. They explained that the clicks were not seconds because I try and time it but it's just clicking to say that the radiation is on. You're not completely sure whether you should be there because everybody goes outside the room, so you think what is this thing that they want to avoid that I'm having. So they go outside and they monitor you from the outside. But that, once they've set you up then the machine is automatic, it would do its 3 positions automatically, I assume automatically, I don't think they're operating it from outside. So that is a very, very precise, very technical operation that is I think particularly good.
 

 

Concludes that radiotherapy is a relatively straightforward procedure.

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Concludes that radiotherapy is a relatively straightforward procedure.

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I had to go back the following week where I saw the radiologist and then I had to lie down on a table and she was looking at this, at these scans and she got a small needle and she said 'What I'm going to do,' she said 'I'm going to give you a tattoo which will last you for the rest of your life,' but she said 'it will only be just a tiny little mark.' And she did one on one thigh on the outside of the thigh, one on the other outside and one just above my penis, just right in the middle of the of the pubic hair which I didn't think they would be able to see it anyway [laughs] but apparently they could. And she said 'Right that's all, now' they said 'we've got to arrange for you to come in for radiotherapy,' they said 'it's going to be about 6 weeks, Monday to Friday,' because they don't work on Saturdays and Sundays so they said I'll have a rest from it. So I did the radiotherapy and that, there's absolute nothing to it whatsoever.

Would you like to explain about it?

Yes of course. You go down into this room and there's all these great big machines in the actual radio department and you just sit there and they call out your name and you go into the room and they've got about 3 nurses there and the nurse says 'Right take your trousers partly way down and get up on the trestle type thing,' whatever it is, you'd like to call it, and they said, just pull me trousers down slightly and put a piece of blue cloth over me and said 'Right this only going to take about 3, 2-3 minutes. We can't be in the room,' they said 'we're in the room outside, but we can see you.' And they said 'you'll hear 3 long buzzes and there was this machine that came over me and it was going round from left to right and when it got to where I had the mark on me thigh there was a ping, you couldn't see any laser or anything like that, you couldn't see any rays, just a ping there and then it moved up, down to the centre of me and there was another ping and then one on the other side. And they said it was the physical rays meeting, the three meeting at one point which is where the tumour was, at the side of the prostate.

How did they stop you moving, did they just say 'lie very still,' or

Yes they just said lie still, they didn't, they don't strap you down or anything, you just put your hands down by your side and you just lay there and think of England [laughs].

 

Describes the treatment and considers it is not invasive or painful.

Describes the treatment and considers it is not invasive or painful.

Age at interview: 70
Sex: Male
Age at diagnosis: 67
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The treatment itself again no pain, not invasive, you lie on a machine, previous to that I should say that in one of the scans, if they recommend radiotherapy you have a scan and obviously the scan highlights the parts that they want to treat with the radiotherapy and to give them an index point they give you 2, 3 pin pricks which are tattoos. They're there for life, small green dots, on one each side and one just below the prostate area on the tummy and when you go in for radiotherapy there are two red indexing beams which focus in on the tattoo points so they know that's the reference points, it's locked. The radiotherapy machine has been pre-programmed by a computer to focus in exactly on the spots that they want to treat and I have found out subsequently that not just the area that they want to treat to be on the safe side they have a peripheral zone beyond that which they treat as well.

However, others thought that psychological aspects were neglected and they felt as though they were on a production line while having radiotherapy. Most of the men we interviewed experienced side effects either during or after treatment (see 'Side effects of treatments').

 

Compares the treatment to factory-like conveyor belt.

Compares the treatment to factory-like conveyor belt.

Age at interview: 70
Sex: Male
Age at diagnosis: 66
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They were a little bit sort of, a bit like a factory you know a bit like 'Oh well here's the next one, here's the next one,' a quick look at your notes, set you up on the table and get all the gear sorted out, make sure that they're lined up with your tattoos and all the rest of it. Because they tattoo you on the sides, well you probably know and they you know line up their equipment to suit that and away they go out the room and leave you with it. But that was okay. I think it's very difficult to be you know sympathetic with everybody and it's just like a factory really, they're all lined up there ready to go you know there'd usually be what 4 or 5 people at a time.

 

Explains the radiotherapy process and gives advice to others.

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Explains the radiotherapy process and gives advice to others.

Age at interview: 69
Sex: Male
Age at diagnosis: 63
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My next effort or result with what was happening was that I was then to have a series of 27 to 30 shots of the radio therapy. This is a horrible thing to go through. First of all you have a little dot put on your tummy so that each time they can set the machine up and they can find this tattoo mark and then the machine sort of lifts itself up, you're steady and it goes round you and then clicks off. You are alone in this room but you haven't got anything to worry about because you can look through a window and see the nurses there. 

They are very, very good indeed, they are very helpful. And when you are going through this series of radiotherapy you certainly need somebody, not only with you because you won't be able to drive or anything after it, you'll have a hell of a job to even to walk 100 yards, but it goes, it goes. Also in 97 I then started going to the pain therapy doctor and this is when you start taking your pills of morphine, and other ones which you will come across in time. Another, going back to the radiotherapy it is most difficult really to explain how things are. You will be very down, everything is such an effort to do and if you're not careful you could say 'Damn it all I'm going to give up,' but don't give up, its not worth it because there's plenty left later on. 
 


 
Last reviewed July 2017.
Last updated July 2017.
 
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