University College Hospital Having radiotherapy to the prostate: preparation for treatment Radiotherapy Department Patient information series No.56
If you would like this leaflet in another language or format, or require the services of an interpreter, contact us on 020 3447 3711. We will do our best to meet your needs. Contents Introduction 3 What is the prostate? 4 Why is bowel preparation important? 5 Why is bladder preparation important? 5 What are fiducial markers? 5 What will happen before my CT scan? 6 The preparation process 6 What is a micro-enema? 7 How do I use a micro-enema? 8 What will happen when I come for my radiotherapy CT planning scan? 9 What will happen when I come for radiotherapy treatment? 10 Patient questions 11 Appointment dates 12 Space for notes and questions 13 Useful contact numbers 14 2
Introduction This booklet has been written for patients who are about to start a course of radiotherapy to the prostate. Before starting radiotherapy planning and treatment you will need to follow special instructions on preparing your bladder and bowels. This preparation process ensures your internal organs (rectum, bladder, small bowel) can be moved away from the area to be treated, and to make sure your internal organs on the treatment days are in the same position as on your radiotherapy planning scan. It is important that you understand and follow the instructions for preparation given to you. This booklet describes what needs to be done and what you need to do throughout your treatment. We understand that this is a worrying time for patients. You may feel that you have been given lots of information about what needs to be done in a short period of time. We hope this booklet answers some of your questions. If you still have any questions or concerns, please let your doctor, nurse or radiographer know. We are here for you. 3
What is the prostate? The prostate is a gland about the size and shape of a walnut. The prostate gland is located in front of the rectum, just below the bladder and it surrounds the urethra (Figure 1). The urethra carries urine from the bladder out through the penis. Figure 1. 4
Why is bowel preparation important? Bowel preparation on a daily basis during your treatment is important because: It will improve the accuracy of your treatment. It will help reduce the risk of any long-term bowel side effects. Why is bladder preparation important? When having radiotherapy to the prostate it is important that you have a comfortably full bladder, and maintain a similar bladder size for each treatment. The reasons for this are: A larger bladder will limit the amount of bladder and small bowel in the treatment area which will help to reduce any side effects you may experience. It will help maintain treatment accuracy on a daily basis. What are Fiducial Markers? Fiducial markers are small seeds usually made of gold or stainless steel implanted via image guided methods into the prostate. They act as a marker for accuracy of treatment. If appropriate for you, your radiotherapy doctor will discuss this process with you, and provide you with information to read. If you are taking an anticoagulant (blood thinning medication), this needs to stop before the fiducial marker insertion as advised by your doctor. If you are taking Warfarin, your doctor will advise you on when to stop taking it prior to fiducial marker insertion. 5
You will be prescribed an antibiotic called ciprofloxacin. Take this medication twice a day, for five days. Start the antibiotics the night before the insertion, with another tablet on the morning of the insertion and then complete the course. What will happen before my CT scan? One to two weeks before your radiotherapy CT planning appointment you will have a phone consultation with a member of the Radiotherapy Review Team to discuss your understanding of the preparation process. The preparation process Bladder preparation: Hydration is essential for your radiotherapy including the planning CT. One week before your planning CT scan, increase your fluid intake so that you are well hydrated. Drink at least two litres of water every day. It is possible to add squash or juice if this makes the water more palatable. You will need a comfortably full bladder for your radiotherapy planning CT scan and treatment. You will be asked to drink a specific amount of water before each appointment. Ensure that you do not drink more than two cups of tea or coffee per day, and your alcohol intake should be limited. At your CT planning scan you will be asked to drink 5 cups of water and comfortably hold in your bladder for 30 to 45 minutes prior to your scan. This will be asked of you every day for treatment also. 6
Bowel Preparation: A daily micro-enema is required to maintain an empty rectum throughout your radiotherapy treatment. This must be carried out even if your regular bowel motions have occurred. Please bring your enemas for all appointments, including your CT planning scan. You will be prescribed micro-enemas to use on a daily basis to prepare your rectum for treatment. The micro-enema causes your rectum to empty with a bowel movement, or passing of wind. The micro-enema will need to be inserted into your rectum. You will be asked to do this for yourself. You will be asked to practice inserting the micro-enemas for five days before your radiotherapy CT planning scan. Once you have had your scan, you will not need to insert the microenemas until the first day of your radiotherapy treatment What is a micro-enema? A micro (small) enema is medication which will cause your rectum to empty with a bowel movement or passing of wind. The micro-enema is contained in a small tube with a nozzle and is designed for easy insertion into the anus (back passage). The medication (5mls) is inserted into your rectum via the nozzle. Although the prospect of using a micro-enema everyday sounds unpleasant, the majority of patients tolerate it well. 7
How do I use the micro-enema? Go to the toilet with the micro-enema and remove the cap. To make it easier to insert the nozzle into your rectum, squeeze out a drop of fluid and spread it over the nozzle. Gently insert the nozzle fully into your rectum and squeeze out all the contents of the tube. Keep squeezing the tube as you remove the nozzle. This action prevents the medication from being drawn back into the nozzle. The need to have a bowel movement is usually felt within 10-15 minutes. If you suffer from haemorrhoids or have problems inserting the microenema, please speak to a member of the radiotherapy review team. Please see the contact details at the end of this booklet. 8
What will happen when I come for my radiotherapy CT planning scan? You can eat and drink normally before you come for your planning CT scan. You will be asked to bring your micro-enemas with you. At this appointment the planning radiographers will ask you to: Empty your bladder. Insert a micro-enema and wait for your bowels to empty. The need to have a bowel movement is usually felt within 10-15 minutes. Even if you have already opened your bowels on the day of your scan, you will still need to use a micro-enema to make sure your rectum is empty. Drink five cups of water, after you have emptied your bowels. This is available in the waiting area. Do not do this until instructed by a radiographer. Wait for 30-45 minutes, to allow for your bladder to fill (comfortably), before you have your radiotherapy planning scan. If you do not feel your bladder is full after 30-40 minutes please tell the radiographers. Please allow around 2 hours for your planning CT appointment. 9
What will happen when I come for radiotherapy treatment? You can eat and drink normally on the day of your radiotherapy appointment. Please arrive at least one hour before your allotted radiotherapy appointment time. At each appointment you will need to: Empty your bladder. Insert a micro-enema and wait for your bowels to empty. The need to have a bowel movement is usually felt within 10-15 minutes. Even if you have already opened your bowels on the morning of your treatment appointment, you will still need to use a micro-enema to make sure your rectum is empty. After emptying your bowels, the radiographers will tell you when to start drinking the prescribed amount of water that you drank at your planning CT scan. This is available in the waiting area. Wait prescribed amount of time advised at your planning CT scan, to allow for your bladder to fill (comfortably), before you have your radiotherapy treatment. For each radiotherapy appointment, you should allow up to two hours. You should aim to arrive at least an hour before your given treatment appointment time, to allow for the above process. It is important that you understand and follow the instructions for treatment preparation given to you. 10
If you have any difficulty following the instructions please discuss this with the radiographers treating you. There may be various reasons for this problem, including side effects to your bladder and bowels. You should only modify the routine for your bladder/bowel preparation as a result of discussion and agreement with your radiotherapy doctor. If you still have any questions or concerns, please let your doctor, radiographer or radiotherapy review team know. We are here for you. Patient questions Do I need to use the micro-enemas over the weekend? No, you only have to use the micro-enemas on the days that you attend for your radiotherapy treatment. Can I eat after inserting a micro-enema? Yes, you can eat normally after inserting a micro-enema. Even if I have emptied my bowels naturally, do I still need to use a micro-enema before my treatment? Yes, even if you have already opened your bowels naturally on the day of your treatment, you will still need to use a micro-enema to make sure your rectum is empty. 11
Appointment dates/times Fiducial marker insertion (Attend UCH 2 nd Floor Imaging): Stop anticoagulants: Start Antibiotics: (Start the antibiotics the night before the insertion, with another tablet on the morning of the insertion and then complete the course.) Planning CT scan (Attend UCH Radiotherapy Basement): First treatment (Attend UCH Radiotherapy Basement): 12
Space for notes and questions 13
Useful contact numbers Brachytherapy Direct telephone: 020 3447 3782 Switchboard: 020 3456 7890 Bleep 1128 Radiotherapy Review Team (Via Radiotherapy reception) Direct telephone: 020 3447 3700/01 Radiotherapy planning department Direct telephone: 020 3447 3750 Radiotherapy reception Direct telephone: 020 3447 3700/ 020 3447 3701 We hope that you have found this booklet helpful. If you have any questions or other worries and would like to speak to someone, please ask a member of staff. If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice. Email: PALS@uclh.nhs.uk Telephone: 020 3447 3042 Website: www.uclh.nhs.uk 14
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First published: June 2008 Date last reviewed: March 2018 Date next review due: March 2020 Leaflet code: UCLH/S&C/CD/RT/PROSTATE/1 University College London Hospitals NHS Foundation Trust 16