Preparing for radiotherapy to the prostate or prostate bed Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
The advice in this booklet explains what you need to do before you attend your CT planning scan, as well as during your radiotherapy treatment. A radiographer will explain what you need to do when you come for your planning scan. Why do I need to follow these instructions? As all of the organs in the pelvis sit very close to each other, following these instructions will help to ensure that your internal organs are in the same position each day Following these instructions can also help to reduce the side effects of your treatment by moving the rectum (back passage), bladder and small bowel away from the treatment area Diagram to show the position of the prostate Bladder Rectum Urethra Penis Treatment Beam Testicle Prostate 2 Preparing for radiotheray to the prostate or prostate bed
What do I need to do? Please start to follow this information from the day you receive this booklet. It is important that you are well hydrated (drinking lots of fluid) and have a comfortably full bladder for your CT scan and treatment. A comfortably full bladder means your bladder feels full but that you don t have the urgency to empty it. How can I be sure I am well hydrated? From today onwards, we ask you to aim to drink 2-3 litres (4-5 pints) of fluid per day. This quantity can be spread out during the day, but avoid drinking excessively in the evening. The fluid doesn t have to be water, but please reduce your intake of caffeinated, fizzy and alcoholic drinks. How can I have a comfortably full bladder? As well as ensuring that you drink this quantity of fluid throughout the day, it may be beneficial to your treatment to practice filling your bladder and keeping it full. We suggest you empty your bladder and drink 500ml (approximately 1 pint) of water within 5 minutes. Then try to wait for 1 hour before passing water. Please try to do this everyday. What if I can t wait that long? If you can t hold 500ml of liquid in your bladder and you need to pass water, try 400ml and again hold for 1 hour. If you still can t hold on, try decreasing the amount of fluid you drink until you find your comfortable amount. Then increase the volume of water daily aiming to get closer to 500ml. What do I need to do during my CT planning scan appointment? Ideally, we would like you to have a comfortably full bladder and an empty rectum (back passage) for your planning scan and each Preparing for radiotheray to the prostate or prostate bed 3
treatment. To empty your rectum we would like you to use a micro-enema. You will be given these at your CT planning scan appointment. These enemas are safe to use unless you are allergic to any of the ingredients: sodium citrate sodium lauryl sulphate sorbitol or you have an inflammatory bowel disease, such as Crohn s. If you think you this may apply to you, please discuss with the radiographer at your scan appointment. A radiographer will explain the procedures below and will give you a supply of micro-enemas to keep at home. How do I use the Micro-enema and fill my bladder? Micro enema tube Cap Nozzle To use the micro-enema: 1. Take an enema tube from the packet and go into the toilet 2. Pull or twist the cap off the end of the nozzle 3. Squeeze a drop of liquid onto your finger and smear over the nozzle 4. Insert the full length of the nozzle into your back passage 4 Preparing for radiotheray to the prostate or prostate bed
5. Gently squeeze the tube until it is empty 6. Keep squeezing the tube as you pull the nozzle out of your back passage. This is to stop the medicine being drawn back into the tube 7. Throw the empty tube into the bin 8. Go back into the waiting room and wait for 15 minutes or until you feel the need to empty your bowels 9. Go back into the toilet and try to empty your bowels. Please don t strain and don t worry if you cannot empty your bowels or if only wind is passed it may be that your back passage is already empty 10. Empty your bladder at the same time. If you have a catheter please ask the radiographers for a clamp and clamp it shut 11. Return to the waiting room and drink 4 cups or 1 pint (½ litre) of water in no more that 5 minutes 12. Your bladder will take at least 30 minutes to fill up after finishing drinking. Please tell the radiographers if you need more filling time 13. If you find that your bladder becomes uncomfortably full, please tell the radiographers. You may need to empty your bladder, drink and fill again. This may delay your appointment time At your radiotherapy treatment Please empty your back passage (steps 1-9) at the radiotherapy department before each radiotherapy treatment or at home (no more than 2 hours before your appointment time) if you live close by. You may find it more comfortable to insert the micro-enema whilst lying on your side on your bed. Please make sure you arrive at the radiotherapy department 60 minutes before your appointment time to use the micro-enema and fill your bladder (steps 1-12). Or if you are using the micoenema at home, please arrive at the radiotherapy department 40 minutes before your appointment time to fill your bladder (steps 10-12). Preparing for radiotheray to the prostate or prostate bed 5
Please bring a spare micro-enema with you in case of delays (see below). To assist the radiographers in positioning you for treatment, it would be very helpful if you could wear either track suit bottoms or trousers with an elasticated waist and slippers for every treatment appointment. What if there is a delay? If you are kept waiting and are unable to hold your bladder full, please tell the radiographers. You may need to empty your bladder, drink and fill again with approximately half the amount of fluid (1-2 cups). Please discuss this with the radiographers if you are unsure of what to do. If more than two hours passes since you emptied your bowels please tell the radiographers. You may need to repeat using the micro-enema. What if I use hospital transport? If you are travelling by hospital transport, we suggest you wait until arriving at the hospital to follow all of the steps above (the same as at your scan appointment). If there is a delay in the treatment room the radiographers will inform you when to fill your bladder (use the enema on arrival). What if I find this difficult? If, at any point during your course of treatment, you have trouble keeping your bladder full or using the micro-enema, please tell a radiographer, nurse or doctor. Is there anything else I can do to help my treatment? We recommend that you also drink plenty of fluids throughout your course of treatment. 6 Preparing for radiotheray to the prostate or prostate bed
Aim for 2-3 litres (4-5 pints) during the day. It is also sensible to drink less caffeinated, carbonated and alcoholic drinks as they can irritate your bladder. We would recommend following a healthy balanced diet during radiotherapy treatment. Please do not be tempted to miss meals. This will not help to keep your rectum empty. It is unlikely that your skin will get sore because of the treatment. However as a precaution we would recommend using a mild or baby soap and avoiding using any products containing metals (e.g. zinc) in your pelvis area during your course of treatment. Appointment times The radiotherapy department is open from 08:00-18:00. You will be offered treatment times within these hours. Car parking Car park D is directly opposite the doors to the Cancer Centre on the hospital drive. If you park here and bring in the ticket you have taken to access the car park, the radiographers on the treatment room will exchange this for a prepaid one so you can exit the car park. This has only been negotiated for patients who are attending for radiotherapy planning or treatment appointments so unfortunately the radiographers will not be able to give you a ticket if you are attending for a follow up appointment. What if I have a question? If you have any questions about preparing for radiotherapy to the prostate or prostate bed, please contact the pre-treatment radiographers on 0121 371 5055. For further information about prostate cancer or radiotherapy in general, please visit the Patrick Room in the foyer of the Cancer Centre. Preparing for radiotheray to the prostate or prostate bed 7
Quick guide to preparation on your treatment days To assist the radiographers, it would be very helpful if you could wear either track suit bottoms or trousers with an elasticated waist and slippers for every treatment appointment. It is important to follow the instructions below each day to help to reduce the side effects of your treatment. 1. Arrive in department at least 60 minutes before your appointment time and use the micro-enema in the radiotherapy department and empty your bladder 2. Empty your bowels if possible 15-20 minutes after your enema 3. 40 minutes before your appointment time fill your bladder with 4 cups or 1 pint (½ litre) of water and drink this within 5 minutes *Please ensure you have a full bladder for your appointment time* We recommend that you also drink plenty of fluids throughout your course of treatment. Aim for 2-3 litres (4-5 pints) during the day. The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit www.uhb.nhs.uk/health-talks.htm or call 0121 371 4957. The Radiotherapy Department Queen Elizabeth Hospital Mindelsohn Way, Edgbaston, Birmingham, B15 2TH Telephone: 0121 371 5055 PI13/0871/03 UHB/PI/0871 (Edition 3) Author: Liz Southgate Date: November 2013 Review date: November 2015