If you decide to have HDR brachytherapy, you will be referred to a specialist who treats cancer with radiotherapy, called a clinical oncologist. The treatment itself may be planned and carried out by specialists including therapy radiographers, radiologists, urologists, physicists and sometimes a specialist nurse.
If you have a large prostate, you may have hormone therapy before brachytherapy starts, to shrink your prostate. If you have a higher risk cancer, you may have hormone therapy before and after treatment. You may also have a short course (three to five weeks) of external beam radiotherapy. You may have this before or after your HDR brachytherapy.
On the morning of your treatment, you will have an enema to help you empty your bowels. An enema is a liquid medication which is inserted directly into your back passage (rectum). It’s important that your bowel is empty so that clear images of your prostate can be taken. The nurse may then give you a tablet to stop you needing to open your bowels when the radiation is being delivered.
You will probably have a general anaesthetic so that you are asleep during the procedure. But you may have a spinal anaesthetic (epidural), so that you are awake but can’t feel anything. Talk to your doctor about which type of anaesthetic you will have – it may depend on what your hospital offers.
Once you have had the anaesthetic, an ultrasound probe will be inserted into your back passage. This scans your prostate to make sure the tubes have been inserted in the right place. Thin tubes are then passed through the perineum, which is the area between the testicles and the opening of the back passage (anus), into the prostate and the surrounding tissues. There are normally 10 to 20 tubes, and once they are in the right position, they are secured in place.
You will also have a catheter fitted, which is a thin tube passed through the penis into the bladder to drain urine.
You will then have a scan – either a computerised tomography (CT) scan, magnetic resonance imaging (MRI) scan or ultrasound scan. Each hospital does things slightly differently and you may need more than one scan. Your doctor will use the scan to plan the doses of radiation needed for your treatment. Read more about scans.
You may still be asleep during the scan, or you may be awake. If you are awake, you will need to lie still during the scan and your treatment. Some men find this uncomfortable.
During treatment, the tubes in your prostate are attached to the brachytherapy machine. A source of radiation attached to a wire is inserted into each tube in turn. The radiation source stays in each tube for a set period of time. The machine automatically removes the source of radiation at the end of the treatment.
Most hospitals just do one treatment, but you may have more than one. This will depend on your hospital. Check with your doctor or nurse how many treatments you will have, and whether you will be asleep or awake during treatment.
In some hospitals, you will have the treatment while you are asleep in the operating theatre and the tubes will be removed before you wake up. In other hospitals, you will have the treatment in the brachytherapy room while you’re awake. The treatment itself is completely painless. The tubes are removed after the treatment has finished.
Two or three treatments in total
If you have more than one treatment, there will be a gap of at least six hours between each one. You will have each treatment in the brachytherapy room while you are awake.
Some hospitals will leave the tubes in place in between each treatment. Some men find this uncomfortable. You normally have to lie on your back and keep still to make sure the tubes don’t move. Some men find it a long time to lie still.
Other hospitals will remove the tubes after each treatment, and insert new ones for the next treatment. Ask your doctor or nurse how they will carry out the treatments.
After the treatment has finished, the nurse will take your catheter out. This might be uncomfortable but should not be painful. Some hospitals will leave the catheter in overnight, until the blood starts to clear from your urine.
Many people feel fine after anaesthetic but some people have side effects such as feeling sick or dizzy. Some men find it difficult to urinate after treatment. You can go home when you have recovered from the anaesthetic and can urinate normally. This may be on the same day as treatment but some men need to stay in hospital overnight.
You shouldn’t drive for 24 to 48 hours after the anaesthetic. Ask a family member or friend to take you home.
Your doctor or nurse will give you any medicines that you need at home. These may include drugs to help prevent urinary problems (such as tamsulosin) and antibiotics to prevent infection. You may be given pain-relieving drugs such as paracetamol or ibuprofen.
You may notice some blood in your urine for a few days after your treatment. You may also have some discomfort and bruising in the area where the tubes were placed. Your bowel movements may also feel a little uncomfortable. This should settle down after a few days.
No radioactive material is left in the prostate, and you won’t give off any radiation. So it’s safe for you to be around other people, including children and pregnant women.
If you are having external beam radiotherapy after the HDR brachytherapy, you will start this around two weeks after your brachytherapy.