About Your MSK Precise® Radiation Therapy for Prostate Cancer

This information will help you get ready for your MSK Precise radiation therapy to your prostate. It explains what to expect. It also explains how to care for yourself before, during, and after your radiation therapy.

This resource has a lot of information. Different sections may be helpful at different times. We suggest reading through this resource once before you start radiation therapy so you know what to expect. Then, refer back to it during your radiation therapy.

The information in this resource is general. Your radiation therapy will be designed specially for you. Some parts of your treatment may be different than what’s described here. Your radiation therapy team will talk with you about what to expect.

About radiation therapy

Radiation therapy uses high-energy radiation to treat cancer. It works by damaging the cancer cells and making it hard for them to multiply. Your body can then naturally get rid of the damaged cancer cells. Radiation therapy also affects normal cells, but they can fix themselves in a way cancer cells can’t.

Radiation therapy takes time to work. It takes days or weeks before cancer cells start to die, and they keep dying for weeks or months after radiation therapy ends.

You’ll have a treatment planning procedure called a simulation before your first radiation treatment. During your simulation, your radiation therapists will take imaging scans and mark your skin with little tattoo dots. This is done to:

• Map your treatment site.
• Make sure you get the right dose (amount) of radiation.
• Limit the amount of radiation that gets to your nearby healthy tissues.

About MSK Precise

MSK Precise is different from traditional radiation therapy. It uses a precise, high-dose form of radiation therapy called stereotactic body radiotherapy (SBRT) to deliver high doses of radiation to tumors accurately.

It’s normal for your prostate and other organs to shift slightly as you move and breathe. This can happen between and during your treatments. Before you start MSK Precise, you may have fiducial markers (tiny metal objects that are visible on imaging scans) placed in your prostate. These markers will help your radiation oncologist know exactly where your prostate is during your treatment. This helps them target high doses of radiation directly to your prostate. You can read more about the markers in the “Fiducial marker and rectal spacer placement” section.

Your MSK Precise radiation therapy will be given in 5 treatments. This is fewer than with other types of radiation therapy because the treatment doses are stronger. During your radiation treatments, a machine will aim beams of radiation directly to the tumor. The beams will pass through your body and damage cancer cells in their path. You will not see or feel the radiation.

MSK Precise can be used alone or along with other treatments for prostate cancer, such as brachytherapy or hormonal therapy.

Your role on your radiation therapy team

Your radiation therapy care team will work together to care for you. You’re a part of that team, and your role includes:

• Getting to your appointments on time.
• Asking questions and talking about your concerns.
• Telling us when you have side effects.
• Telling us if you’re in pain.
• Caring for yourself at home by:
  • Quitting smoking, if you smoke. MSK has specialists who can help. To learn more about our Tobacco Treatment Program, call 212-610-0507.
  • Caring for your skin based on our instructions
  • Drinking liquids based on our instructions.
  • Eating or avoiding the foods and drinks we suggest.
  • Taking your bowel prep medicines based on our instructions.
  • Staying around the same weight.

What happens before MSK Precise radiation therapy

Fiducial marker and rectal spacer placement

Before you start MSK Precise, you might have a procedure to place fiducial markers, a rectal spacer, or both.

• Fiducial markers are tiny metal objects (about the size of a grain of rice). They help your healthcare providers line up the beams of radiation and make sure your radiation treatments are delivered exactly the same way each time. This helps them target the tumor and avoid your nearby healthy tissue. The fiducial markers will stay in your prostate after your treatment.
• A rectal spacer is a gel called SpaceOAR® hydrogel that’s placed between your prostate and rectum (the lower end of your colon) to move them apart. This protects your rectum from radiation and reduces some side effects of radiation therapy. The rectal spacer will stay in place for about 3 months. Then, it’ll be absorbed by your body and come out in your urine (pee).

If you’re getting fiducial markers or a rectal spacer, your healthcare provider will talk with you about what to expect. They will also give you the resource About Your Fiducial Marker and Rectal Spacer Placement.

Sperm banking

Your testes will be exposed to radiation during your radiation therapy. This can affect your sperm production and your ability to have biological children after radiation therapy. If you think you may want to have biological children, we recommend banking your sperm before you start treatment.

To learn more, read Sperm Banking and Building Your Family After Cancer Treatment: For People Born With Testicles.

Bowel preparation

You’ll need to clear extra stool (poop) from your body for your simulation and radiation treatments. This is called bowel preparation, or bowel prep. Bowel prep helps lower your risk of side effects.

How bowel prep lowers risk of side effects

Your bowels are your small intestine, large intestine (colon), and rectum. Your rectum is where stool is stored before it leaves your body.

Your bowels get bigger or smaller based on how full they are. When they change size, they also move the tissue and organs around them, including your prostate and bladder.

Bowel prep empties your bowels. It helps the tumor and nearby healthy tissues be in the same place for your simulation and treatments. This helps keep healthy tissues safe from too much radiation and lowers your risk of side effects.

Bowel prep supplies

You’ll need these supplies:

• Methylcellulose dissolvable fiber supplement, such as Citrucel® powder.
• Simethicone 125 milligram (mg) tablets, such as Gas-X® Extra Strength.
• 6 saline enemas, such as Fleet® saline enemas.

You can buy these at your local pharmacy without a prescription.

Bowel prep instructions

It is very important to follow your bowel prep instructions. If your bowel isn’t empty before your simulation and treatments, you may need an extra enema. It can also delay your simulation or treatment.

A member of your radiation therapy team will tell you exactly when to start your bowel prep. You’ll start at least 3 days before your simulation appointment.

• Take 1 tablespoon of methylcellulose powder every day. Dissolve it in liquid following the instructions on the package.
• Take 2 (125 mg) simethicone tablets the night before your simulation and treatment appointments.
• Use a saline enema about 3 hours before your simulation and treatment appointments.
• Take 2 (125 mg) simethicone tablets about 2 hours before your simulation and treatment appointments.

Keep taking the methylcellulose powder every day until you finish your radiation therapy.

If your care team gives you different instructions, follow those instead.

Diet guidelines to minimize bloating

During your radiation therapy, gas or fluid can build up in your bowels and cause bloating. When your bowels are bloated, they can expand into the treatment area and be exposed to radiation. This can cause side effects or make your side effects worse.

Follow the guidelines below to lower your risk of bloating during radiation therapy. It’s best to start 2 to 3 days before your simulation and continue until you have finished your radiation therapy.

• Chew your food well.
• Limit or avoid foods that release gas when they’re digested, such as:
  • Asparagus
  • Beer
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Cauliflower
  • Corn
  • Dried beans, peas, and other legumes
  • Garlic
  • Leeks
  • Milk and other dairy products with lactose (if you’re lactose-intolerant)
  • Onions
  • Prunes
• Avoid carbonated (fizzy) drinks, such as sodas and sparkling waters.
• Limit or avoid sugar alcohols, such as xylitol, sorbitol, and mannitol. Sugar-free foods often have sugar alcohols. If you’re not sure, check the ingredients list on the food’s Nutrition Facts label.
• Choose cooked vegetables instead of raw vegetables.
• Depending on your symptoms, your healthcare provider may tell you to eat more or less fiber. Follow their instructions.

If you’re bloated or feel gassy, keeping a food journal can help you see which foods may be causing it. Write down your foods and drinks, the time you have them, and the time you start feeling bloated. Bring your food journal to your appointments. Your healthcare provider will use it to help you manage the bloating.

A clinical dietitian nutritionist can talk with you about your diet and help you design an eating plan that meets your needs. If you’d like to meet with a clinical dietitian nutritionist, ask your radiation oncologist or nurse for a referral.

Drink water, if needed

Some people need to have a full bladder during their simulation and radiation treatments. Having a full bladder can help push your small intestine out of the treatment area. This helps keep side effects from starting or getting worse.

Your care team will tell you if your bladder should be full for your simulation and radiation treatments. They will tell you how much water to drink before each of your appointments. They will also tell you when to start drinking it.

Stay hydrated before appointments, if needed

If you’ll need a full bladder, stay well hydrated in the days before and the day of your appointments. Drink water throughout the day and whenever you feel thirsty. This helps the water your care team told you to drink before your appointment fill your bladder more quickly. It takes about 30 to 60 minutes for a bladder to fill when your body is properly hydrated. It takes longer if you’re dehydrated.

It’s important to drink water to stay hydrated. Other liquids (such as coffee, hot chocolate, and tea) don’t fill your bladder as well as water does.

Simulation appointment

Medicines to take

The night before your simulation appointment:

• Take 2 (125 mg) simethicone tablets.

The day of your simulation appointment:

• Take 1 tablespoon of methylcellulose powder like usual.
• Give yourself a saline enema about 3 hours before your appointment. Follow the instructions on the box.
• Take 2 (125 mg) simethicone tablets about 2 hours before your appointment. These are in addition to the tablets you took the night before.
• Take your usual medicines.

You’ll be lying still in one position during your simulation. If you think you’ll be uncomfortable, take an over-the-counter pain medicine or your usual pain medicine 1 hour before your simulation. Talk with your healthcare provider ahead of time.

If you think you may get anxious during your simulation, talk with your healthcare provider ahead of time. They may suggest medicines to help.

What to eat and drink

It’s OK to have a light meal, unless your healthcare provider tells you otherwise.

If your care team gave you instructions for drinking water before your appointment, follow their instructions.

What to wear

Wear comfortable clothes that are easy to take off. You will need to change into a hospital gown.

Take devices off your skin

You may wear certain devices on your skin. Before your simulation or treatment, device makers recommend you take off your:

• Continuous glucose monitor (CGM)
• Insulin pump

If you use one of these, ask your radiation oncologist if you need to take it off. If you do, make sure to bring an extra device to put on after your simulation or treatment.

You may not be sure how to manage your glucose while your device is off. If so, before your appointment, talk with the healthcare provider who manages your diabetes care.

What to expect when you arrive

A member of your radiation therapy team will check you in when you arrive. They’ll give you an identification (ID) wristband with your name and date of birth. Many staff members will check your ID wristband and ask for your name and date of birth during your appointment. This is for your safety. People with the same or a similar name might be having care on the same day as you.

Your radiation therapists will greet you and take a photo of your face. This picture will be used to identify you throughout your radiation therapy. They’ll also review what to expect during the simulation. If you haven’t already signed a consent form, the radiation therapists will go over the form with you. They will answer any questions you have and ask for your signature.

Your radiation therapists may also ask you to drink water so your bladder is full before your simulation. They will tell you how much to drink. Having a comfortably full bladder and empty bowel helps move your healthy tissue away from the radiation beams. This helps lower your risk of side effects.

When it’s time for your simulation, you’ll change into a hospital gown. Keep your shoes on.

What to expect during your simulation

Your radiation therapists will help you onto the simulation table. The table will have a sheet on it, but it’s hard and doesn’t have a cushion. If you haven’t taken pain medicine and think you may need it, tell your radiation therapists before your simulation starts.

Your radiation therapists will help you get into position for your simulation. You will lie on your back with your head on a headrest. Your radiation therapists will move your legs and feet into lower body immobilization cushions (see Figure 1). These are hard cushions that keep your legs and feet in place. You’ll use them for your simulation and all your treatments so you’re in the exact same position every time. If you need a higher headrest or knee cushion to be comfortable, please ask.

Your simulation will take 1 to 2 hours but can be shorter or longer depending on your specific treatment. Your radiation therapists can play music for you to help pass the time.

Do not move once your simulation starts. It’s important that you stay in the same position. If you’re uncomfortable or need help, tell your radiation therapists.

Imaging scans and positioning

Throughout your simulation, your radiation therapists will use imaging scans to check and adjust your positioning. They will see the fiducial markers in your prostate on these images. They will also check that your bladder is full and your bowels are empty.

The imaging scans may be done on an x-ray machine called a simulator or on a computed tomography (CT) scan machine. You may also have a magnetic resonance imaging (MRI) scan. These scans are only used to plan your treatments. They are not used for diagnosis or to find tumors.

If there’s not enough liquid in your bladder or too much stool or gas in your bowels, your radiation therapists will help you off the simulation table. They will give you time to fill your bladder or empty your bowels. They’ll bring you back to the simulation room later.

If you have too much gas in your bowels and can’t release it yourself, your radiation therapists may be able to help. They can place a small, lubricated rubber tube into your rectum to remove the gas if it’s easy to reach.

You’ll feel the simulation table move into and out of the scanner and hear the machine turn on and off. Even if it seems loud, your radiation therapists will be able to hear you if you need to speak with them. They will walk in and out of the room during the scans, but the room has a microphone, speaker, and camera. There will always be someone who can see and hear you.

Your radiation therapist will turn the lights in the room on and off during your simulation. You will see red or green laser lights on each wall. Your radiation therapists use them to help position you on the table.

Skin markings (tattoos) and photographs

Your radiation therapists will use a felt marker to draw on your skin in the treatment area. Once they’re sure you’re in the right position, they’ll make a few tiny tattoos using a clean needle and a drop of ink. Each tattoo will feel like a pinprick. The tattoos will not be bigger than the head of a pin.

Your radiation therapists will also take several photos of you in your simulation position. They’ll use the photos and tattoos to position you correctly on the table each day of your treatment.

You can wash off the felt markings after your simulation. The tattoos are permanent and will not wash off. If you’re concerned about having tattoos as part of your radiation treatment, talk with your radiation oncologist.

Scheduling your radiation treatments

We will schedule your set-up procedure and radiation treatment appointments before you leave your simulation appointment.

MSK Precise radiation treatments are given daily or every other day from Monday through Friday. Your treatment can start any day of the week. You’ll have a total of 5 treatments.

Each treatment appointment usually takes about 20 to 30 minutes, as long as you have a full bladder and empty rectum. Your appointments will be longer if you need to fill your bladder or empty your rectum. They will also take longer if you have a planned status check visit with your radiation oncologist.

If you can’t come in for a treatment for any reason, call your radiation oncologist’s office to tell your radiation therapy team. If you need to change your schedule for any reason, speak with your radiation therapists.

Checking your treatment schedule

You can see your treatment schedule in your patient portal, MyMSK (my.mskcc.org). If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

It’s very helpful to use MyMSK to keep track of your appointment times. We will call you if we need to reschedule any of your treatment appointments.

Treatment planning

Between your simulation and first treatment, your radiation oncologist will work with a team to plan your treatments. They will use your simulation scans to carefully plan the angles and shapes of your radiation beams. They’ll also figure out the dose of radiation you’ll get. These details are carefully planned and checked. This can take up to 2 weeks.

Your treatment plan is based on your body shape and size at the time of your simulation. Try to keep your weight within 5 to 10 pounds (2.3 to 4.5 kilograms) of your usual weight. This helps make sure your radiation treatment plan stays accurate.

What happens during MSK Precise radiation therapy

Remember to keep taking methylcellulose powder every day until you finish your radiation therapy.

Keep following the diet guidelines to minimize bloating until you finish your radiation therapy.

Radiation treatment appointments

Medicines to take

The night before each treatment appointment:

• Take 2 (125 mg) simethicone tablets.

The day of each treatment appointment:

• Take 1 tablespoon of methylcellulose powder like usual.
• Give yourself a saline enema about 3 hours before your appointment.
• Take 2 (125 mg) simethicone tablets about 2 hours before your appointment.
• Take your usual medicines.

You’ll be in the same position for your radiation treatments as you were for your simulation. If pain or anxiety medicine was helpful for your simulation, you may want to take it before your radiation treatments. Take it about 1 hour before your appointment.

What to wear

Wear comfortable clothes that are easy to take off. You will need to change into a hospital gown.

What to eat and drink

It’s OK to have a light meal, unless your healthcare provider tells you otherwise.

If your care team gave you instructions for drinking water before your appointment, follow their instructions.

What to expect when you arrive

Each day you have treatment, check in at the reception desk and have a seat in the waiting room. If you need a full bladder for your treatment, your radiation therapist will tell you how much water to drink and when to start drinking it.

When your radiation therapists are ready for you, a staff member will bring you to the dressing room. They will give you a hospital gown to change into. Keep your shoes on.

Your radiation therapists will bring you into the treatment room and help you onto the treatment table.

Set-up procedure and first treatment

When you come in for your first treatment appointment, you’ll have special imaging scans before your treatment starts. This is called a set-up procedure. This appointment will take slightly longer than your other treatment appointments.

Radiation treatments

Your radiation therapists will help you get into your treatment position. Then, they will leave the room, close the door, and start taking imaging scans. You will have X-ray scans, CT scans, or both.

You will have these imaging scans daily throughout your treatment. Your radiation therapists will use them to check and adjust your position. They will also check that your bladder is full and your bowels are empty. Your radiation oncologist may also use these imaging scans to adjust your treatment plan. They are not used to see how your tumor is responding to treatment.

Breathe normally during your treatment, but do not move. You will not see or feel the radiation. You may hear the machine as it moves around you and is turned on and off. If you’re uncomfortable and need help, tell your radiation therapists. They will be able to see and hear you. They can turn off the machine and come in to see you at any time, if needed.

You’ll be in the treatment room for 15 to 45 minutes, depending on your treatment plan. Most of this time will be spent putting you in the correct position. The treatment only takes about 10 to 15 minutes.

You will not be radioactive during or after treatment. It’s safe for you to be around other people and pets.

Status check visits

Your radiation oncologist or radiation nurse will check in with you at least once during your treatment. They’ll talk with you about any concerns, ask about any side effects you may be having, and answer your questions. This status check visit may be a telemedicine visit or a visit before or after your treatment.

If you need to speak with your radiation oncologist or nurse outside your status check visits, call your radiation oncologist’s office. You can also ask another member of your care team to contact them when you come in for treatment.

Vitamins and dietary supplements during radiation therapy

It’s OK to take a multivitamin during your radiation therapy. Do not take more than the recommended daily allowance (RDA) of any vitamin or mineral.

Do not take any other dietary supplements without talking with a member of your care team. Vitamins, minerals, and herbal or botanical (plant-based) supplements are examples of dietary supplements.

Side effects of MSK Precise radiation therapy

Some people have side effects from radiation therapy. Which side effects and how severe they are varies from person to person. Your healthcare provider will talk with you about what to expect based on your medical history and specific treatment plan.

This section explains the most common side effects of MSK Precise radiation therapy. You may have all, some, or none of these. Most of these side effects will go away several weeks to months after you finish radiation therapy. If you have any of these side effects, your healthcare provider will give you more information and help you manage them.

Urinary changes

Your prostate gland might swell and the lining of your bladder might become irritated. Because of this, you may:

• Have trouble starting to urinate (pee).
• Need to urinate more often than usual.
• Need to urinate at night more often than usual.
• Have sudden urges to urinate.
• Feel a burning sensation when you urinate.

Tell your radiation oncologist or nurse if you have any urinary changes. They can recommend a change in your diet or prescribe medicine that can help. You can also follow the guidelines below.

• Drink 6 to 8 (8-ounce) cups of water throughout the day.
• Avoid drinking after 8 p.m.
• Avoid foods and drinks that may irritate your bladder, such as:
  • Drinks with caffeine, such as coffee, tea, and soda.
  • Alcohol.
  • Acidic foods and drinks, such as tomatoes, citrus fruits and juices, and carbonated (fizzy) drinks.
  • Spicy foods, especially if you feel burning when you urinate.
• Do pelvic floor muscle (Kegel) exercises. Read Pelvic Floor Muscle (Kegel) Exercises for Males to learn how. A member of your care team will tell you how many to do and how often to do them.

To learn more about managing urinary changes, read Improving Your Urinary Continence.

Bowel changes

The wall of your rectum can become irritated. After a few treatments, you may:

• Have bowel movements (poop) more often than usual.
• Have softer stool than usual.
• Feel discomfort in your rectum.
• Have mucous discharge from your anus. Your anus is the opening of your rectum where stool leaves your body.
• Have a small amount of bleeding from your rectum. For example, you may see bright red blood on your toilet paper or stool.
• Pass more gas than usual.
• Feel like you need to have bowel movements more urgently than usual.

If you have hemorrhoids, radiation therapy can make your hemorrhoid symptoms worse.

These symptoms are usually mild.

If you have any of these side effects, tell your radiation nurse. They can talk with you about how you can change your diet to manage them. If you’re still uncomfortable, tell your radiation oncologist or nurse. Your radiation oncologist can prescribe medicine to help.

These side effects can last for about 1 to 2 months after you finish radiation therapy. Some people keep taking medicines to treat urinary changes after they finish radiation therapy. It’s important to tell us if you develop side effects and keep us informed on how you’re doing.

Sexual and reproductive health

You can be sexually active during radiation treatment, unless your radiation oncologist gives you other instructions. You will not be radioactive or pass radiation to anyone else. It’s safe to be in close contact with others.

You may have discomfort or feel a burning sensation during ejaculation. For most people, this goes away 1 to 2 months after finishing radiation therapy.

If you’re sexually active with someone who can get pregnant, it’s very important to use birth control (contraception) during and for 1 year after your treatment. During your radiation therapy, your sperm may be damaged by the radiation. If you conceive a baby with this sperm, the baby might have birth defects. Using birth control helps prevent this.

To learn more about sexual health during cancer treatment, read Sex and Your Cancer Treatment. The American Cancer Society also has resources about sexual health issues during cancer treatment. The one for males is called Sex and the Adult Male with Cancer. You can search for it at www.cancer.org or call 800-227-2345 for a copy.

Male Sexual and Reproductive Medicine Program

MSK’s Male Sexual and Reproductive Medicine Program helps people address their disease and treatment’s impact on their sexual health. You can meet with a specialist before, during, or after your treatment. We can give you a referral, or you can call 646-888-6024 for an appointment.

Skin and hair reactions

You probably will not notice any changes in your skin in the treatment area. You might lose some or all of the hair in your pubic area. The hair usually grows back 3 to 6 months after you finish radiation therapy. The color and texture might be different.

Fatigue

Fatigue is feeling very tired or weak. When you feel fatigue, you may not want to do things. You may have trouble focusing, feel slowed down, or have less energy than usual.

You might start to feel fatigue during treatment or in the weeks after starting treatment.  It can range from mild (not bad) to severe (very bad). It may be worse at certain times of day. Fatigue may last 6 weeks to 12 months after your last treatment.

There are lots of reasons you may feel fatigue during your radiation therapy. They include:

• The radiation’s effects on your body.
• Traveling to and from your treatment appointments.
• Not getting enough restful sleep at night.
• Not getting enough protein and calories.
• Having pain or other symptoms.
• Feeling anxious (nervous) or depressed (unhappy).
• Side effects of some medicines.

Ways to manage fatigue

• If you’re working and are feeling well, it’s OK to keep working. But working less may help you have more energy.
• Plan your daily activities. Pick the things you need or really want to do. Do them when you have the most energy. For example, you may choose to go to work but not do housework. You may choose to watch your child’s sports event but not go out to dinner.
• Plan time to rest or take short (10- to 15-minute) naps during the day, especially when you feel more tired.
• Try to sleep at least 8 hours every night. This might be more sleep than you needed before you started radiation therapy. You might also find it helpful to:
  • Go to sleep earlier at night and get up later.
  • Be active during the day. For example, if you’re able to exercise, you can go for a walk or do yoga.
  • Relax before going to bed. For example, read a book, work on a puzzle, listen to music, or do another calming hobby.
• Ask family and friends to help with chores and errands. Check with your insurance company to see if they cover home care services.
• You might have more energy when you exercise. Ask your radiation oncologist if you can do light exercise, such as walking, biking, stretching, or yoga. Read Managing Cancer-Related Fatigue with Exercise to learn more. 
• Eat foods that are high in protein and calories. Read Eating Well During Your Cancer Treatment to learn more.

Some things can make your fatigue worse. Examples are:

• Pain
• Nausea (feeling like you’re going to throw up)
• Diarrhea (loose or watery poop)
• Trouble sleeping
• Feeling depressed or anxious

If you have these or any other symptoms or side effects, ask your radiation oncologist or nurse for help.

Emotional health

You might also worry about telling your employer you have cancer or about paying your medical bills. You may worry about how your family relationships may change, or that the cancer will come back. You may worry about how cancer treatment will affect your body, or if you will still be sexually attractive.

It’s normal and OK to worry about all these things. All these kinds of feelings are normal when you or someone you love has a serious illness. We’re here to support you.

Ways to cope with your feelings

Talk with others. When people try to protect each other by hiding their feelings, they can feel very alone. Talking can help the people around you know what you’re thinking. It might help to talk about your feelings with someone you trust. For example, you can talk with your spouse or partner, close friend, or family member. You can also talk with a chaplain (spiritual advisor), nurse, social worker, or psychologist.

Join a support group. Meeting other people with cancer will give you a chance to talk about your feelings and learn from others. You can learn how other people cope with their cancer and treatment and be reminded you are not alone.

We know that all cancer diagnoses and people with cancer are not the same. We offer support groups for people who share similar diagnoses or identities. For example, you can join a support group for people with breast cancer or for LGBTQ+ people with cancer. To learn about MSK’s support groups, visit www.msk.org/vp. You can also talk with your radiation oncologist, nurse, or social worker.

Try relaxation and meditation. These kinds of activities can help you feel relaxed and calm. You might try thinking of yourself in a favorite place. While you do, breathe slowly. Pay attention to each breath or listen to soothing music or sounds. For some people, praying is another way of meditation. Visit www.msk.org/meditations to find guided meditations lead by our Integrative Medicine providers.

Exercise. Many people find that light movement, such as walking, biking, yoga, or water aerobics, helps them feel better. Talk with your healthcare provider about types of exercise you can do.

We all have our own way of dealing with difficult situations. Often, we use whatever has worked for us in the past. But sometimes this is not enough. We encourage you to talk with your doctor, nurse, or social worker about your concerns.

What happens after MSK Precise radiation therapy

Follow-up appointments

It’s important to come to all your follow-up appointments with your radiation oncologist. During these appointments, they will check how you’re recovering after your your radiation therapy.

Write down your questions and concerns before your follow-up appointments. Bring this and a list of all your medicines with you. You can also call your radiation oncologist or nurse any time after you finish radiation therapy or between follow-up appointments.

Vitamins and dietary supplements after radiation therapy

• You might be getting other cancer treatments along with your radiation therapy. If you are, ask the doctor managing that treatment when it’s safe to start taking dietary supplements again. Some dietary supplements are not safe to take before surgery or during chemotherapy.
• If you are not getting other cancer treatments, you can start taking dietary supplements again 1 month after your last radiation treatment.

If you want to talk with a clinical dietitian nutritionist about your diet or supplements, tell your radiation nurse.

Urinary and bowel changes

Some people develop side effects 4 months or more after treatment. These may be similar to the ones you had during treatment. There’s a very small chance you may develop other side effects. For example:

• The opening of your bladder may become more narrow.
• You may have blood in your urine.
• You may have bleeding from your rectum.

These side effects are rare. They may come and go over time. Or, they may be persistent and chronic. Your care team will help you manage them.

Even if you don’t develop any late side effects, remember that your radiation therapy affected the tissues in your bladder and rectum t. Call your radiation oncologist if you:

• Have any new urinary, bladder, or bowel symptoms.
• Need to have a colonoscopy. Avoid having a colonoscopy for the first year after treatment.
• Need any type of urological or rectal procedure.

Sexual changes

Some people develop sexual changes after finishing treatment. For example:

• It might be more difficult or not possible to get or keep an erection. This is called erectile dysfunction (ED).
• Your orgasms may feel different.
• When you ejaculate, the amount or thickness of your semen may be different.

These changes may happen many months or even years after radiation therapy. If you notice any of them, tell your healthcare provider. They can give you a referral to a healthcare provider who treats these problems.

MSK support services

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.

Integrative Medicine Service
www.msk.org/integrativemedicine
646-608-8550
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.

Male Sexual & Reproductive Medicine Program
646-888-6024
This program helps male patients who are dealing with cancer-related sexual health challenges, including erectile dysfunction.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.

Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. To learn more, call Rehabilitation Medicine (Physiatry) at 646-888-1929.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. To learn more, call Rehabilitation Therapy at 646-888-1900.

Questions to ask your radiation oncologist

Before your appointment, it’s helpful to write down questions you want to ask. Examples are listed below. Write down the answers during your appointment so you can review them later.

What kind of radiation therapy will I get?

How many radiation treatments will I get?

What side effects should I expect during my radiation therapy?

Will these side effects go away after I finish my radiation therapy?

What kind of late side effects should I expect after my radiation therapy?

Instructions before your appointments

Starting 3 days before your simulation appointment

Before your simulation and treatment appointments