Prostate cancer radiotherapy
A course of carefully planned radiation that aims to treat prostate cancer, given either as daily beams from outside the body or as radioactive sources placed inside the prostate.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Radiotherapy aims to treat prostate cancer using planned radiation; it is a treatment, not surgery, and there is no incision or scar.
- It cannot promise a cure and does not treat cancer outside the area that is planned and treated; success is judged over years using PSA tests.
- A full course usually means several visits, and side effects on the bladder, bowel and erections can build up during treatment and sometimes appear or persist later.
- Good care is led by a multidisciplinary team and a clinical oncologist who explains the aim of treatment, the alternatives, and how side effects will be monitored.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can treat prostate cancer that is contained in or near the prostate, aiming for long-term control
Cancer that has spread widely may be treated with a different aim, so radical radiotherapy to cure may not be the right approach.
Bladder and bowel symptoms and tiredness often build up, typically starting in the first week or two and being most troublesome near the end. Tell your...
A named contact route for side-effect questions during and after the course.
Bladder and bowel symptoms and tiredness often build up, typically starting in the first week or two and being...
Acute bladder and bowel side effects usually settle over this period. Tiredness can take longer to lift.
Energy gradually returns. PSA is monitored and expected to fall slowly over many months rather than immediately.
Some effects, such as erection changes, bowel or bladder problems, or rarely a urinary stricture, can appear or...
What is prostate cancer radiotherapy?
Prostate cancer radiotherapy uses controlled doses of high-energy radiation to damage cancer cells in the prostate so they cannot keep growing. It is a treatment, not an operation, so there is no surgical wound or 'scar'. It is one of the main ways to treat prostate cancer that has not spread, and it can be used in different situations and with different intent.
Most people have external beam radiotherapy, where a machine directs beams at the prostate from outside the body across a number of daily sessions (called fractions). Some people instead, or as well, have brachytherapy, where radioactive sources are placed inside the prostate. Your team will recommend an approach based on the type and risk group of your cancer, your symptoms, your general health and your own preferences.
For many men with cancer that is contained in or near the prostate, radiotherapy aims to control the cancer for the long term. It is often combined with hormone therapy. For cancer that has spread, radiotherapy can still be used with a different aim, such as easing symptoms. It is important to understand which aim applies to you.
Radiotherapy treats the prostate and the area planned by your team. It cannot guarantee that cancer will never come back, and it does not treat cancer outside the treated area. Decisions are normally made by a multidisciplinary team (MDT) that reviews your scans, biopsy and PSA results together.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Radiotherapy compared with surgery for localised prostate cancer
| Point | Radiotherapy | Surgery (prostatectomy) |
|---|---|---|
| What happens | Planned radiation over days/weeks; no operation | Operation to remove the prostate |
| Hospital | Usually outpatient (EBRT) | Inpatient operation and recovery |
| Main early effects | Bladder and bowel irritation, tiredness | Wound, catheter, surgical recovery |
| Erection effects | Often gradual over time | Often early, may improve over time |
| Monitoring | PSA, expected to fall slowly | PSA, expected to become very low |
There is no single right choice. Both can be effective for suitable cancers; the trade-offs in side effects differ. Your MDT and your own priorities should guide the decision.
Preparing for your treatment
- See a clinical oncologist who explains the aim of treatment (to control the cancer or to ease symptoms), the type of radiotherapy and the likely side effects.
- Expect a planning appointment with a CT scan, sometimes with an MRI, and small skin marks or tattoos to line up treatment accurately.
- Follow any instructions about a comfortably full bladder and an empty bowel before sessions, as this helps protect healthy tissue.
- Tell your team about bowel conditions such as inflammatory bowel disease, previous pelvic radiotherapy, hip replacements, diabetes or anticoagulant medicines.
- Discuss hormone therapy if it is recommended, including when it starts, how long it lasts and its own side effects.
- Ask about fertility and sperm banking before starting if having children may matter to you.
- Plan for daily travel to the centre across the course, and for tiredness that can build up over the weeks.
- For brachytherapy, follow fasting and anaesthetic instructions and arrange someone to take you home.
What happens
For external beam radiotherapy, you first have a planning session. You lie in the treatment position and have a CT scan, sometimes with an MRI, and the team may place small permanent skin marks to line up the beams. The physics and clinical team then design your individual plan, which takes a few days.
Each treatment session is usually not painful and quick. You lie still while the machine moves around you and delivers the beams; the radiographers leave the room but watch and talk to you. You do not become radioactive and are safe around others. You usually attend once a day, Monday to Friday, for the number of sessions in your plan.
Brachytherapy is done in theatre under a general or spinal anaesthetic. Using ultrasound guidance, the team places radioactive seeds permanently, or fine tubes for a temporary high dose-rate treatment, into the prostate. You may go home the same day or stay briefly, and you will be given specific safety advice.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Cancer that has spread widely may be treated with a different aim, so radical radiotherapy to cure may not be the right approach.
- Significant bowel conditions such as inflammatory bowel disease can make pelvic radiotherapy riskier.
- Previous pelvic radiotherapy may mean the area cannot be safely re-treated.
- Severe pre-existing urinary problems may make some approaches, especially brachytherapy, unsuitable.
Delay or rearrange if…
- You have an active urinary or other infection that needs treating first.
- Your bladder or bowel symptoms are unstable and need optimising before planning.
- Important staging scans or biopsy results are still awaited.
- Medication issues, such as anticoagulants, need to be reviewed before brachytherapy.
Alternatives to discuss
- Surgery to remove the prostate (radical prostatectomy) for suitable cancers.
- Active surveillance for low-risk cancer that may not need immediate treatment.
- Hormone therapy alone or as part of a wider plan in some situations.
- Watchful waiting where treatment side effects would outweigh the benefit, especially with other serious illness.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can treat prostate cancer that is contained in or near the prostate, aiming for long-term control
- Avoids an operation and a general anaesthetic for external beam treatment
- Image-guided techniques shape the dose to protect the bladder and bowel as much as possible
- Can be combined with hormone therapy to improve control in higher-risk cancer
- Can also be used with a different aim, such as relieving symptoms when cancer has spread
Risks & complications
- Tiredness that builds up over the course and can last weeks afterwards
- Needing to pass urine more often or urgently, with a burning feeling or slower stream
- Looser or more frequent bowel motions during treatment
- Skin redness or soreness in the treated area
- Inflammation of the back passage (proctitis) causing straining, mucus or some bleeding
- Ongoing bladder irritation or, over time, narrowing of the urine tube (a stricture)
- Difficulty getting or keeping an erection that may develop gradually
- Reduced or 'dry' ejaculation and changes to fertility
- Persistent bowel problems such as bleeding, urgency or, rarely, more serious bowel injury
- Long-term urinary leakage (uncommon, and complete loss of control is very uncommon)
- A small increased risk of a second cancer of the bladder or rectum years later
- Serious complications needing further procedures
The biggest uncertainties are how your bladder, bowel and erections will be affected, and whether the cancer is fully controlled, which is only judged over years through PSA tests. Risk is higher if brachytherapy is combined with external beam radiotherapy, and pre-existing bowel disease, urinary problems or previous pelvic radiotherapy all matter. Ask your clinical oncologist what the aim of treatment is for you, how your side effects will be monitored, and what the plan is if the PSA rises.
Published figures to discuss
Side-effect and control rates vary widely with the type and risk group of the cancer, the radiotherapy technique and dose, whether brachytherapy is combined with external beam, and your own health. Reputable UK patient sources describe most side effects in plain terms (such as 'common', 'uncommon' or 'a small number') rather than giving single fixed percentages, and outcomes are judged individually over years. For this reason we describe risks qualitatively rather than inventing exact figures.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Urinary frequency, urgency or burning during treatment | Common | Symptoms usually improve after treatment but can persist or recur in a minority. | Guide sourcesClinical context |
| Bowel urgency, looseness or rectal bleeding | Common acutely; persistent rectal bleeding is less common | Modern planning reduces rectal dose but cannot eliminate bowel risk. | NICE NG131 — Prostate cancer: diagnosis and management (recommendations)nice.org.ukSource-linked context |
| Erectile dysfunction after radiotherapy | Common over time, influenced by age, baseline function, hormone therapy and vascular health | Sexual function should be discussed before treatment and supported afterwards. | Guide sourcesClinical context |
| Biochemical recurrence after radical radiotherapy | Variable by PSA, Gleason/grade group, stage and hormone-treatment use | Ask for risk-group-specific control figures rather than one prostate-radiotherapy number. | NICE NG131 — Prostate cancer: diagnosis and management (recommendations)nice.org.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Radiotherapy does not have a surgical recovery, but side effects often build up towards the end of the course and for a few weeks afterwards before settling. Some effects appear or persist later, which is why follow-up matters.
- Tiredness that lingers for several weeks after the course finishes
- Bladder and bowel irritation that gradually eases over the weeks after treatment
- A PSA that falls slowly, sometimes with a temporary small rise ('bounce') that is not always a sign of relapse
- Skin in the treated area that settles, with no external scar
Aftercare
- Drink enough fluid and follow any bladder and bowel advice your team gives during and after the course.
- Use any recommended creams for skin soreness and avoid harsh products or rubbing the treated area.
- Report bowel bleeding, severe urgency, inability to pass urine or signs of infection promptly.
- Keep follow-up appointments and PSA blood tests so control can be monitored over time.
- Discuss erection changes openly; treatments and support are available and improve outcomes.
- Continue any hormone therapy exactly as prescribed and ask about its own side effects.
- Tell future dentists, surgeons and doctors that you have had pelvic radiotherapy if you need other treatment.
- Daily travel to the centre arranged for the whole course
- Questions about the aim of treatment written down for your clinical oncologist
- Hormone therapy schedule understood, if relevant
- Sperm banking discussed before starting, if fertility matters
- Bladder/bowel preparation instructions noted
- Clinic contact number saved for side-effect questions
- Follow-up and PSA testing plan understood
⚠ Get urgent help if…
- Being completely unable to pass urine (a medical emergency)
- Heavy or persistent bleeding from the back passage or in the urine
- Fever, shivering or feeling very unwell (possible infection)
- Severe or worsening tummy or pelvic pain
- Severe diarrhoea causing dehydration
- Any new severe or unexpected symptom during or after treatment
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result means the cancer is controlled with side effects you can live with. With radiotherapy, this is judged over months and years using PSA blood tests, which are expected to fall slowly rather than disappear immediately. A small temporary rise can happen and is not always relapse.
Radiotherapy cannot prove that cancer will never return, and it does not treat cancer outside the treated area. Your team will explain what your PSA pattern means for you and what would happen if it rose, including further tests or treatment.
For cancer contained in or near the prostate, radiotherapy aims for long-term control, and many men do well for years. Outcomes vary by the risk group and stage of the cancer, your general health and other factors, so honest, individual discussion matters more than any single figure. Because some side effects can appear late, long-term follow-up is part of the plan.
Related tests, treatments or support
Radiotherapy for prostate cancer is often combined with hormone therapy, particularly for intermediate- and higher-risk cancer, and external beam radiotherapy is sometimes combined with a brachytherapy boost. The right combination depends on your cancer's risk group and your general health, and each part adds its own benefits and side effects.
Follow-up & long-term care
After treatment you have regular reviews and PSA blood tests, often for several years, to check that the cancer is controlled and to manage any side effects. Many services move people who are doing well to patient-initiated follow-up, where you contact the team if you have concerns. Late effects are watched for, and you should report new urinary, bowel or other symptoms between appointments.
- Regular PSA blood tests on the schedule your team advises
- Ongoing review of any bladder, bowel or erectile side effects
- Continuing and then stopping hormone therapy as planned, with its own monitoring
- Bone and general health checks if you are on long-term hormone therapy
Repeat, follow-on and what comes next
- Control is judged over years by PSA; a sustained rise prompts further tests and a discussion about additional treatment.
- Re-treating the same area with radiotherapy is often not possible, so options after relapse may differ from the first treatment.
- Some side effects, such as a urinary stricture or erectile problems, may need their own treatment later.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact route for side-effect questions during and after the course.
- A clear PSA monitoring schedule and a written plan for what a rising PSA would trigger.
- Proactive support for erectile, urinary and bowel side effects rather than leaving you to cope alone.
- Coordination between private and NHS teams so your records and follow-up join up.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of radiotherapy (external beam, stereotactic or brachytherapy) and number of sessions
- Planning scans (CT and sometimes MRI) and the physics planning involved
- Whether hormone therapy is included and for how long
- The clinical oncologist's fees and the centre or facility fees
- Anaesthetic and theatre costs for brachytherapy
- Follow-up appointments, PSA monitoring and management of any side effects
- The clinical oncologist's fees and the radiotherapy facility fees
- Planning scans and the physics planning
- Anaesthetic and theatre costs if you are having brachytherapy
- Any hormone therapy and its monitoring
- Follow-up appointments and PSA blood tests
- What happens, and who pays, if you develop a complication or need further treatment
- How private care will be coordinated with your NHS team
On the NHS? Prostate cancer radiotherapy is a standard NHS treatment when clinically indicated; private care may be used for speed, choice of centre or a second opinion, and is coordinated with NHS teams.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being clear whether the aim is to control the cancer or to ease symptoms.
- Glossing over long-term bladder, bowel and erectile side effects, or the effects of hormone therapy.
- Not discussing alternatives such as surgery or active surveillance.
- No clear plan for PSA monitoring or for what happens if the cancer comes back.
- Not mentioning fertility and sperm banking before treatment starts.
Marketing red flags
- Promoting a specific machine or technique as a guaranteed cure or as having 'no side effects'.
- Naming a branded system as automatically better without discussing your individual cancer.
- Pushing treatment without an MDT discussion or without offering alternatives.
- Downplaying the effect on erections, bladder and bowel, or the burden of hormone therapy.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is the aim of my radiotherapy to control the cancer or to ease symptoms?
- Which type of radiotherapy do you recommend for me, and why, and how many sessions?
- Do you recommend hormone therapy as well, and for how long?
- What are my likely bladder, bowel and erection side effects, both early and long term?
- How will you monitor my PSA, and what would you do if it rose?
- How does radiotherapy compare with surgery or active surveillance for my cancer?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is prostate radiotherapy available on the NHS or only privately?
Does radiotherapy cure prostate cancer?
Will it affect my erections and sex life?
Does the treatment hurt, and will I be radioactive?
How many sessions will I need?
What if my PSA goes up afterwards?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Prostate Cancer UK — External beam radiotherapy Prostate Cancer UK — High dose-rate brachytherapy Cancer Research UK — External radiotherapy side effects (prostate) Cancer Research UK — Long-term side effects (prostate radiotherapy) NICE NG131 — Prostate cancer: diagnosis and management (recommendations) Macmillan — Brachytherapy for prostate cancer
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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