Our radiation oncologists and nurses are here to guide you through each step of your radiation therapy. Below you’ll find information about what to expect during your prostate cancer radiation treatment. If you have any questions, please do not hesitate to contact us.

Your Initial Visit for Radiation Therapy

To develop your prostate cancer radiation plan, you will first meet with a radiation oncologist from our prostate cancer team.

Your first visit will last around one hour.

We will discuss:

  • Details of your prostate cancer diagnosis
  • Your medical history
  • Any testing and imaging that you’ve had (including pathology report)
  • Other factors that help determine which treatment is right for you (e.g., your current bowel, urinary and erectile function)

As part of this radiation plan meeting, we’ll identify whether you are a candidate for Think Five radiation therapy. Our Think Five approach delivers a full course of radiation therapy in only five visits. 

If you are not a candidate for Think Five, your radiation treatments will typically last five to six weeks, with five visits per week for a total of around 28 visits.

Your Prostate Cancer Radiation Treatment at Valley

We invest in the latest radiation technology so that radiation is as safe and accurate as possible. This commitment to safety includes our use of fiducial markers, SpaceOAR hydrogel spacer and stereotactic body radiation therapy combined with the ExacTrac Dynamic motion monitoring system.

Fiducial Markers and SpaceOAR

For prostate stereotactic body radiation therapy (SBRT) at Valley, we first implant fiducial markers and SpaceOAR hydrogel.

These are implanted in one 30-minute procedure. The implantation is performed under general anesthesia in our same-day surgical center within the cancer center.

  • Fiducial markers are tiny gold markers that we implant in your prostate. Fiducials guide our delivery of radiation by enhancing our ability to detect subtle changes in prostate position. Because the markers show up on imaging, we are able to deliver radiation more accurately and consistently at each session.
  • SpaceOAR is a semi-solid gel that creates space between your prostate and rectum. This extra space protects your rectum from radiation and reduces radiation side effects.

How to Prepare for Fiducial and SpaceOAR Implantation

You will need to have additional tests to be cleared for the implantation procedure.

Nurses in our office will walk you through the scheduling process for the procedure and the tests you need. You will leave your first visit with us with an appointment for the implantation procedure.

We will also give you information about how to prepare for your procedure. This will include instructions to:

  • Take an antibiotic for five days starting one day before the procedure
  • Perform an enema at home following instructions we will provide
  • Not eat or drink after midnight the night before the procedure

Fiducial and SpaceOAR Implantation

  • Fiducial implantation: During the procedure, your radiation oncologist will use ultrasound to look at your prostate and insert two needles (through your skin) into the prostate. The needles will place four gold fiducials into your prostate. They will stay there permanently.
  • SpaceOAR implantation: After the fiducials are implanted, your radiation oncologist will insert a needle (through the skin) into the space between your prostate and rectum. Your doctor will inject saline to open up the space. Then, your doctor will inject the SpaceOAR hydrogel, which forms a temporary space between your prostate and rectum. The gel will begin to dissolve in about six months.

Following the procedure, you will be expected to rest for the remainder of the day. You may resume all regular activities the next day.

Treatment Planning

One week after your procedure, you will meet with your radiation oncologist for your radiation planning.

Here’s what to expect:

  • You will be instructed to have a bowel movement before you arrive. You will also be instructed on how much water to drink so you have a comfortably full bladder.
  • First, you will have a new MRI of your prostate performed. This will provide your doctor with a detailed view of your prostate anatomy and the position of the implanted prostate fiducials and spacer.
  • Then you will have a stereotactic fixation device created. This device will keep you from moving during each of your treatments; it will be created specifically for your body.
  • You will have a CT scan performed in your fixation device.

Over the next two weeks, we will create your radiation plan. After creating the plan, we test it to verify it works exactly how we want it to.

During that time, you may continue all your normal activities.

Stereotactic Body Radiation Therapy

After our planning and testing period, you will start your radiation therapy.

For stereotactic body radiation therapy at Valley, we use the Varian TrueBeam™ platform combined with the BrainLab ExacTrac Dynamic system. This system allows us to visualize your internal anatomy before and during treatment.

This visualization allows us to see whether your bladder is filled appropriately, that there isn’t too much gas in your rectum, and that your prostate is aligned correctly for treatment.

During treatment:

  • During treatment, you will lie on the table in your fixation device. You should not feel any discomfort as the treatment is happening.
  • Once treatment begins, the BrainLab ExacTrac Dynamic system monitors the surface of your body and the implanted fiducials in your prostate for any movement.
  • If your prostate moves, the machine will stop the radiation beam automatically and adjust your position. It will then restart treatment.

Treatment length:

  • TrueBeam is much faster than other linear accelerators (such as the CyberKnife), which means there is less time for the prostate to move.
  • For the Think Five approach, you will have five treatments spread out over approximately 10 days. Each treatment will last 30 – 45 min, which includes all the time for changing, set up, position verification, and treatment.
  • Alternatively, you may be recommended to receive 28 treatments—five days a week for five to six weeks. Each treatment will last 15 – 20 minutes.

Activity during and after your course of radiation treatment:

  • You will have no restrictions on your activity or ability to work. When your treatments are finished, you can go home and back to your normal routine.
  • You will not have limitations on your sexual activity. However, if you are having sexual intercourse with a woman of child-bearing age, you should use protection for at least six months following radiation treatments (from end of treatment). This is to prevent the risk of birth defects.
  • You will not have restrictions on contact with other people.

Prostate Cancer Radiation Side Effects

The precision radiation therapy we use at Valley can significantly reduce many of the common side effects of prostate cancer radiation therapy. However, you may experience some of the side effects below.

Short-term Radiation Side Effects

Urinary and Bowel Issues

During and after radiation treatment, patients may experience:

  • Increase in frequency of urination (i.e., needing to urinate more often, including frequent urination at night)
  • Increased feeling of urinary urgency (i.e., a strong, sudden need to urinate)
  • Less forceful urinary stream
  • Slight burning feeling when urinating
  • Slight increase in the frequency of bowel movements (i.e., needing to have bowel movements more often)
  • Slight increase in bowel urgency (i.e., a strong, sudden to need to have a bowel movement)

These symptoms are usually mild; however, they may be treated with slight dietary modification and/or medications if they are bothersome. 


  • Patients often experience mild fatigue (or tiredness) after treatment. You may feel tired as if you went to the beach that day.
  • The fatigue typically resolves within six to eight weeks. 

Erectile Function and Ejaculation

  • In the short term, patients’ erectile function typically remains the same after treatment as before.
  • Erectile function usually declines with age. Patients may eventually experience a decrease in erectile function after radiation; however, it is not always clear how much is due to normal aging versus radiation.
  • After prostate radiation, patients often produce less ejaculate (semen) due to long-term effects on prostate function.

How Long Side Effects Last and Red Flags

  • Most of the above radiation side effects will go away six to eight weeks after treatment. Patients rarely have lingering side effects that last longer.  
  • If you develop any unusual side effects (e.g., fever, pain or blood in urine), notify your radiation team immediately. These side effects may indicate an infection.  

Long-term Radiation Side Effects

  • Rectal bleeding: Patients have a small risk of long-term rectal bleeding with bowel movements. Fortunately, this risk has significantly decreased with hydrogel spacers like SpaceOAR. If you see blood in your stools, contact your radiation team and/or primary care doctor to determine the cause.
  • Urinary symptom flare: Occasionally, urinary symptoms may increase (or flare up) six to 18 months after treatment. This increase typically goes away on its own or in response to anti-inflammatory medication.  

Recovery from Radiation Therapy

You will likely have a follow-up appointment within four to eight weeks after your radiation treatments end.

We will check to make sure any treatment-related side effects have resolved or are improving.

PSA Tests after Treatment

After treatment ends, you will follow up with your urologist to resume prostate-specific antigen (PSA) surveillance. We recommend:

  • You have your first PSA test three months later
  • Then you have one every six months for the first three to five years
  • After that, you have yearly exams

PSA typically declines over time. However, it is common to experience a PSA bounce within the first couple of years after treatment. This is normal.

Please discuss any concerns you have over your PSA value with your radiation oncologist.

Taking Care of Your Overall Health

  • We encourage all our patients to use this opportunity to improve their overall health.
  • We recommend you meet with a dietitian and exercise regularly (to the extent you can with other medical conditions). The Valley Health and Wellness Center offers an exercise therapy evaluation, which we can refer you to as desired.
  • You may also wish to meet with one of our social workers to address issues that can affect your overall health (e.g., financial stress). Social workers can also connect you other Valley cancer support services.