Brachytherapy for Prostate Cancer: LDR, HDR and What Patients Should Know?

What Is brachytherapy?

Brachytherapy prostate cancer treatment involves placing radioactive material inside the prostate. This highly conformal technique allows a high, concentrated dose of radiation to reach the cancer cells whilst limiting exposure to nearby healthy structures, such as the bladder and the rectum. It is commonly used for men diagnosed with early or favourable intermediate-risk prostate cancer.

How brachytherapy works

The brachytherapy procedure for prostate cancer delivers radiation directly into the prostate using small radioactive sources. The emitted radiation damages the DNA of the cancer cells, aiming to stop them from dividing and growing. The targeted nature of the treatment is designed to reduce harm to the delicate organs immediately adjacent to the prostate gland.

Doctors and the wider team use real-time imaging guidance, often involving ultrasound and MRI, to ensure accurate placement of the radioactive material. This precision is essential for achieving optimal dose delivery and minimising the risk of side effects. The procedure is usually performed under a general or spinal anaesthetic in a hospital setting.

LDR vs HDR brachytherapy

There are two main types of brachytherapy for prostate cancer: low dose rate (LDR) and high dose rate (HDR). Both aim to treat the cancer effectively but differ significantly in how the radiation dose is delivered. The appropriate choice depends on the patient’s specific tumour characteristics and the overarching treatment plan.

Low dose rate (LDR)

LDR brachytherapy, often called permanent seed implantation, involves placing dozens of tiny radioactive seeds permanently inside the prostate. These metallic seeds, roughly the size of a grain of rice, release low-energy radiation continuously and slowly over several months. As the isotope naturally decays, the level of emitted radiation gradually decreases until the seeds become biologically inactive.

High dose rate (HDR)

HDR brachytherapy uses highly potent, temporary radioactive sources to deliver a high dose of radiation over a very short timeframe. The radioactive source is passed through a network of temporary catheters inserted into the prostate. After the calculated treatment time, the source and the catheters are removed. This approach allows the clinical team to exercise precise control over radiation delivery.

Who is brachytherapy suitable for?

Brachytherapy is not indicated for every patient, but it can be an effective option for certain clinical groups. Careful, multidisciplinary assessment is required to determine whether it is an appropriate pathway. Specialist consultants carefully consider the cancer stage, prostate volume, baseline lower urinary tract symptoms, and overall cardiovascular health.

Men with localised prostate cancer

Men presenting with localised prostate cancer are often evaluated for internal radiation therapies. The treatment aims to work best when the cancer is confined entirely to the prostate. For individuals with favourable intermediate-risk disease, brachytherapy can provide a targeted approach associated with strong cancer control outcomes. However, it is not generally recommended as a standalone treatment for high-risk disease.

Patients seeking minimally invasive treatment

Some men actively prefer a treatment pathway that avoids major pelvic surgery. Brachytherapy offers a less invasive alternative compared to radical prostatectomy. Because the procedure avoids large incisions and the physical removal of the gland, recovery times are typically much shorter, and hospital stays are generally limited to a day case or a single overnight admission.

Those unsuitable for surgery

Men who may not be medically fit to undergo prolonged surgery due to health concerns or advanced age may also benefit from brachytherapy. It provides an alternative to more physically demanding treatments, making definitive cancer control an option for a wider demographic of patients.

What happens during brachytherapy?

The brachytherapy procedure for prostate cancer is carefully planned and delivered by a specialist team. Imaging and precise placement techniques are used to ensure accuracy. The process differs depending on whether an LDR or HDR pathway is chosen.

LDR brachytherapy step by step

• The patient undergoes pre-operative scans and detailed planning tests to allow the medical physics team to map the prostate’s exact volume and determine the optimal distribution of the radioactive seeds.
• The procedure is usually carried out under general or spinal anaesthetic. Fine needles are inserted through the skin between the scrotum and anus. The radioactive seeds are then placed into the prostate using imaging guidance.
• The seeds stay in the prostate permanently after the procedure. They release radiation slowly over time to treat the cancer. The level of radioactivity fades naturally.
• Most men go home the same day or after a short hospital stay. Follow-up appointments are arranged to check recovery and monitor PSA levels. The team also explains any temporary precautions to follow at home.

HDR brachytherapy step by step

• The patient has a planning appointment before treatment. This may include scans, blood tests, and a review of the prostate. The team uses this information to map the treatment area.
• The procedure is carried out under anaesthetic. Thin tubes or catheters are inserted into the prostate through the skin between the scrotum and anus. Their position is checked using imaging.
• A radioactive source is passed through the catheters for a short time. It delivers a high dose of radiation directly into the prostate. The treatment is carefully controlled by the clinical team.
• The radioactive source is removed once the treatment is complete. The catheters are also removed before the patient leaves. No radiation remains in the body after an HDR session is concluded.

Effectiveness of brachytherapy

Brachytherapy for prostate cancer has been widely studied and is considered an effective treatment option. Long-term oncological outcomes depend heavily on factors such as the initial stages of prostate cancer and the histological grade of the tumour.

Cancer control outcomes

Studies show that brachytherapy prostate cancer treatment can provide high rates of cancer control, particularly in early-stage cases. It is often comparable to other treatments such as radiotherapy or surgery. Long-term monitoring is still required to assess outcomes.

For patients with higher-risk disease, combining brachytherapy with external beam radiotherapy and hormone therapy is often intended to improve overall biochemical progression-free survival. Treatment plans are carefully tailored to balance oncological effectiveness with the preservation of functional quality of life.

Side effects and recovery after brachytherapy

Like all treatments, brachytherapy can cause side effects. The specific profile varies between individuals and depends on the prescribed radiation dose and the patient’s baseline urinary function. Most acute side effects are medically manageable and tend to improve over time.

Short-term effects

Common short-term effects include lower urinary tract symptoms, such as an urgent need to urinate, increased frequency, or discomfort. A small proportion of men may experience temporary urinary retention requiring a catheter. Some patients also report mild fatigue or transient bowel irritation. These symptoms usually peak within the first few weeks and gradually settle.

Patients are given guidance on managing side effects at home. Regular follow-up helps track recovery. Most men return to normal activities relatively swiftly.

Long-term side effects

Long-term side effects can include changes in urinary function or erectile dysfunction. These risks are generally lower than with more invasive treatments but can still occur. The likelihood depends on individual factors and treatment type.

The likelihood of retaining natural erectile function is highly dependent on the patient’s baseline potency and the proximity of the radiation dose to the neurovascular bundles. Careful patient selection and early intervention can help manage any lasting effects.

Safety around others

LDR: Because the permanent seeds emit low-level radiation for several months, national guidance mandates simple safety precautions. Patients are advised to limit close physical contact with pregnant women and children under the age of puberty for the first two months. Additionally, patients must use condoms for the first few ejaculations due to a very small risk of seed migration. These precautions are temporary and are clearly detailed by the medical team.

HDR: no radioactive sources remain in the body after treatment. There is no risk to others once the procedure is complete. Patients can resume normal interactions without restrictions.

Is brachytherapy right for you?

Choosing the right oncological pathway depends on a complex interplay of clinical and personal factors. Every patient’s situation is unique, and healthcare decisions should be made through a process of shared decision-making with expert multidisciplinary guidance.

Factors to consider

Several factors influence whether brachytherapy is appropriate:

• Stage and grade of cancer
• Prostate size and anatomy
• Overall health and fitness
• Personal priorities regarding side effects

Reviewing the stages of prostate cancer helps determine suitability. Imaging such as MRI also plays a key role in planning treatment. A full assessment ensures the most appropriate option is selected.

Questions to ask your consultant

Preparing questions for your urologist can help you feel more confident about your decision. Clear communication ensures you understand the clinical benefits and the potential risks of each proposed treatment.

Useful questions may include:

• What are the expected outcomes of brachytherapy (for my stage and my grade)?
• What side effects are most likely in my case, how will they be managed?
• Are there alternative treatments I should consider?

How Focal Therapy Clinic can help

The Focal Therapy Clinic offers expert guidance for men exploring treatment options. Its consultants include experienced urologists, oncologists, and specialists who review each case in detail. This multidisciplinary approach ensures personalised care.

The clinic provides advanced treatments such as HIFU and NanoKnife, focusing on managing the disease while aiming to preserve the patient’s long-term quality of life. With a strong commitment to clinical excellence, patients also benefit from detailed second opinions and access to objective advice across a wide range of sub-speciality expertise.

References

British Association of Urological Surgeons. (2024). Brachytherapy planning for prostate cancer. Available at: https://www.baus.org.uk/_userfiles/pages/files/patients/leaflets/Brachy%20planning.pdf

European Association of Urology. (2026). EAU Guidelines on Prostate Cancer. Available at: https://uroweb.org/guideline/prostate-cancer/

Macmillan Cancer Support. (2026). Brachytherapy for prostate cancer. Available at: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/brachytherapy-for-prostate-cancer

Oxford University Hospitals NHS Foundation Trust. (2024). Low dose rate prostate brachytherapy. Available at: https://www.ouh.nhs.uk/media/hmilmtjv/91017brachytherapy.pdf

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