Temporary brachytherapy, also known as high dose-rate (HDR) brachytherapy, involves inserting a source of high dose-rate radiation into the prostate gland for a few minutes at a time to destroy cancer cells. It is not available at every treatment centre in the UK.

You may be suitable for this treatment if your cancer is thought to be contained within the  prostate gland (localised prostate cancer) and is 'medium risk'. Your cancer may be described as medium risk if:

Some men whose prostate cancer is beginning to spread to the area just outside the prostate (locally advanced prostate cancer), or with higher Gleason scores, may be able to have temporary brachytherapy. Check with your doctor or nurse.

You may have this treatment on its own or you may have it together with external beam radiotherapy and/or hormone therapy.

There is another type of brachytherapy called permanent seed or low dose rate brachytherapy that involves implanting tiny radioactive seeds into the prostate.

What other treatments are available?

What are the advantages and disadvantages?

Advantages

  • Treatment in hospital with temporary brachytherapy takes just one or two days.
  • It delivers a high dose of radiation direct to the prostate gland so healthy tissue nearby only gets a small dose of radiation and therefore is less likely to be damaged and cause side effects.
  • Recovery is quick, which means you can usually return to your normal activities within a week of treatment.

Disadvantages

  • It can cause side effects such as urinary, bowel and erection problems.
  • You will need a general or spinal anaesthetic. See the section 'What does treatment involve?'
  • If you require more than one radiation treatment you may need to stay in bed for at least six hours between treatments whilst the tubes are in your prostate. Some men find this very uncomfortable. See the section 'What does treatment involve?'
  • You may need to stay in hospital overnight.
  • It may be some time before you will know whether the treatment has been successful.

What does treatment involve?

It is likely that you will have a general anaesthetic so that you are asleep during the procedure. Another option is to have a spinal or epidural anaesthetic, so that you are awake but cannot feel anything. The specialist team will discuss the different options with you.

The specialist passes thin plastic or metal tubes through the area of skin between your testicles and opening of the back passage (perineum) into the prostate gland and the surrounding tissues. You will then have a computerised tomography (CT), magnetic resonance (MRI) or ultrasound scan. This allows the specialist to plan the doses of radiation needed for your treatment.

You may have your treatment while you are still under anaesthetic, or you may have it once you have woken up. During treatment, flexible tubes from the brachytherapy machine are attached to each of the tubes that are inside you. A highly radioactive pellet then travels down each of the tubes in turn. You may have just one treatment or you may have two or three treatments in total.

You will have a follow-up appointment a few weeks after your treatment, to check your PSA level and discuss any side effects. You will have regular appointments after that to monitor your PSA level and any side effects. If your treatment has been successful, your PSA level should drop.

What are the side effects?

The most common side effects include tiredness, problems passing urine, erection problems, and bowel problems. These will affect each man differently, and you may not get all of the side effects.

Some men who have temporary brachytherapy and external beam radiotherapy together find that they have worse side effects. If you already had urinary, erection or bowel problems before treatment, these may be worse after treatment.

Questions to ask your doctor or nurse

  • Will I have external beam radiotherapy before or after temporary brachytherapy?
  • Do I need hormone treatment before and/or after temporary brachytherapy?
  • What are the chances of side effects such as urinary problems, erection problems and bowel problems with this treatment?
  • How many treatments will I have? Will I be asleep or awake during treatment?
  • How long will I need to stay in hospital for the treatment?
  • How will we know if the treatment has worked?
  • What should my PSA level be after treatment and how often will you measure it?
  • If my PSA continues to rise, what other treatments are available?

References

  • Full list of references used to produce this page  

    1. Al-Salihi O, Mitra A, Payne H. Challenge of dose escalation in locally advanced unfavourable prostate cancer using HDR brachytherapy. Prostate Cancer Prostatic Dis. 2006;9(4):370-3.
    2. Morton GC. The emerging role of high-dose-rate brachytherapy for prostate cancer. Clinical Oncology. 2005; 17:219-227.
    3. Pisansky TM, Gold DG, Furutani KM et al. High-Dose-Rate Brachytherapy in the Curative Treatment of Patients with Localised Prostate Cancer. Mayo Clin Proc 2008; 83(12):1364-72.
    4. Morton GC, Loblaw DA, Sankreacha R et al. Single-fraction high-dose-rate brachytherapy and hypofractionated external beam radiotherapy for men with intermediate-risk prostate cancer: analysis of short- and medium-term toxicity and quality of life. Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):811-7. Epub 2009 Oct 14
    5. National Institute for Health and Clinical Excellence. Interventional procedures overview - High dose rate brachytherapy for localised prostate cancer. London: NICE; 2006
    6. Crook J. The role of brachytherapy in the definitive management of prostate cancer. Cancer/Radiotherapie 2011; 15: 230-237.
    7. Prada PJ, Gonzalez H, Fernadez J et al. Biochemical outcome after high-dose-rate intensity modulated brachytherapy with external beam radiotherapy: 12 years of experience. BJUI 2011; 109: 1787-1793.
    8. Mydlo JH & Lebed B. Does brachytherapy of the prostate affect sperm quality and/or fertility in younger men? Scandinavian Journal of Urology & Nephrology. 38(3):221-4, 2004
    9. Royal College of Physicians. The effects of cancer treatments on reproductive functions. Guidance on Management. Report of a Working Party 2007. Available at: http://www.rcr.ac.uk/docs/oncology/pdf/Cancer_fertility_effects_Jan08.pdf
    10. Boehmer D, Badakhshi H, Kuschke W et al. Testicular Dose in Prostate Cancer Radiotherapy: Impact on Impairment of Fertility and Hormonal Function Strahlenther Onkol 2005: 181(3):179-84
    11. Khasksar SJ, Laing R W & Langley S E Fertility after prostate brachytherapy BJU Int. 2005;96(6):915.
    12. O’Connor KM & Fitzpatrick JM. Side-effects of treatments for locally advanced prostate cancer. BJU International. 2005; 97:22-28.