Daily Preparation for Radiotherapy Treatment

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Important instructions for patients having a course of radiotherapy for cancer of the prostate.

Why have I been given this information?

Your oncologist (specialist cancer doctor) has decided that you would benefit from a course of radiotherapy treatment to your prostate or prostate bed. This booklet has been written to give you with the information you need to prepare yourself every day for your treatment.

By following these instructions, you are helping to make sure that:

• your treatment is as accurate as possible
• potential side effects are reduced

Where is my Prostate gland located?

Your prostate gland is located directly below your bladder and in front of your rectum (bottom) as shown below.
 

Why is treatment preparation so important?

Radiotherapy treatment is designed to be extremely accurate. It will only target a certain area, which is decided by the oncologist. 

This means that the treatment area (prostate gland or prostate bed) can be given the least possible amount of radiation without causing damage to the surrounding organs.

To be able to do this, it is important that the prostate gland or prostate bed is always in the same place.

As you can see from the diagram, the prostate sits very close to both the bladder and the rectum. 

As both of these can vary in size depending on how full they are, this can then change the position of the prostate gland.

The following preparation will help to make sure that the bladder and rectum are roughly the same size every day: this is with your bladder comfortably full and rectum empty. This keeps the prostate gland in a steady position.

How do I prepare for treatment?

You will be given a box of micro-enemas. These are prescribed for you by your oncologist.

If you do not have a prescription for these we will arrange for them to be given to you at your CT planning scan appointment.

A micro-enema is a medication inserted into the bottom which will release any faeces (poo) or gas.

The next page shows the instructions for the bladder and bowel preparation that you need to do for you CT planning scan and all of your treatment appointments.

Do not worry if you have questions or can no remember what to do, because you can ask for this information to be repeated to you as many times as you need it.

Please follow this process before EVERY treatment, on the day of your appointment:

• Two hours before your appointment: Administer one enema
• Wait up to 15 minutes after the enema was used and then try to empty your bowels and bladder (poo and wee).
• 40 minutes before the appointment: drink 4 cups of water (500ml in total) one after the other, quickly. Then wait: do not empty your bladder.
• You will be called in for your planning CT scan or treatment once 40 minutes has passed.

What should I do to make this process easier?

There are a few small changes you should make to help prepare for treatment.

1. Keeping well hydrated throughout the day will ensure that the water you drink fills your bladder effectively. From today, please aim to drink between 1.5-2L of water, squash or similar daily.
2. Reducing bowel gas is important to give an emptier rectum. Production of bowel gas (flatulence) is a natural part of the digestion process. Everyone has gas, which is expelled through burping or from the back passage. Too much gas in the treatment area can make it difficult to treat you and cause delays in your treatment. It is therefore important we reduce this.

The best ways to do this are:

• Eat slowly, chew food well and don’t talk while eating
• Avoid constipation
• Reduce foods that can cause gas such as cabbage, corn, brussel sprouts, onions and beans. Ensure they are well cooked to reduce the gas production.  
• Reduce any foods that contain artificial sweeteners known as sugar alcohols e.g. sorbitol and xylitol
• Take small sips rather than gulps when drinking
• Avoid chewing gum or sucking boiled sweets
• Avoid fizzy drinks including carbonated water, soft drinks, lager and beer.
• Try to keep active: walking or even stretching helps to move gas through the intestine more easily.
• It is important to eat regularly– missing meals can cause excess gas to form.

Sometimes your planning CT scan may show you have too much poo or gas in your bowel. If this happens we will need to reschedule you CT scan for a few weeks.

It may be helpful to keep a food and hydration diary to identify if any foods are causing gas and you are drinking the required amount daily –1.5L-2L. If you struggle to drink the required amount of fluid daily try and build this up slowly until you have your planning CT scan.

You may also want to see if you can hold your bladder for 40 minutes after drinking 4 cups of water. The best way to do this by emptying your bladder and then drinking 4 cups of water and holding. If you are struggling then try and build the amount of time you can hold slowly until you find the maximum time you can hold comfortably before emptying.

You will receive a letter in the coming weeks to invite you to attend a group presentation about radiotherapy preparation. So, if you do have any questions please write them down and a member of staff will answer them on the day .

Please print off the PDF version to fill in the form.

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