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Radiotherapy concentrates beams of high-energy waves on the cancerous area. It does not make the patient radioactive and is a painless treatment designed to kill cancer cells while doing as little damage to normal cells as possible. It works because it stops cells from reproducing and therefore rapidly replicating cells such as cancer cells are more susceptible to the effects of radiation than normal cells. In order to minimize damage to healthy cells the patient will go through a simulation where the radiation oncologist will plan the treatment. The doctor will decide on the dose of radiation required and will work to protect the normal cells by shielding them from exposure to the radiation. The course of treatment will also be spread out over a number of weeks to provide both optimum effectiveness and further protection to the normal cells.

During simulation small, permanent tattoo marks will be made on the patient's skin and a mold will be made of the lower body. Photographs will be taken of the patient in the simulation position and the radiation oncologist will use these to help prescribe the treatment. All of these procedures are carried out to ensure that during each treatment session the patient is in an identical position while receiving the radiotherapy.

Radiotherapy is normally delivered daily, five days a week, for around nine weeks. During this time the urologist is in weekly contact with the patient so any side effects can be noted and confronted. There is not usually skin reaction to radiotherapy, although some patients do experience short-term loss of pubic hair. There can be urinary side effects such as increased frequency of urination (especially during the night) and irritation. Another possible side effect can relate to the bowel as the wall of the rectum can become irritated during prostate radiation. These problems include frequency or urgency of movement, rectal discomfort or cramping, mucous discharge and rectal bleeding. All of these symptoms will generally subside within a few months of the radiation treatment concluding. However, there are instances when side effects are long term and this can particularly relate to sexual issues such as changes in the ability to achieve or maintain erection and changes in the sensation of orgasm.

After radiotherapy it is not possible to immediately determine the affects of treatment on the cancer. This will usually be investigated in further visits where PSA levels will be tested.