High-Dose Rate Brachytherapy

High-dose rate (HDR) brachytherapy is a prostate cancer treatment that delivers radiation directly to your tumor while avoiding the healthy tissues surrounding it. Compared to other radiation therapies delivered externally, it’s able to deliver much higher amounts of radiation due to its accuracy, and can help supplement other treatments as well.

Excluding planning and preparation, the procedure can be completed in under two hours, making it comparably convenient to the alternative low-dose rate (LDR) brachytherapy. The total dose of radiation for your treatment may be delivered in one session, or split into two sessions, also known as “fractions”. Fortunately, prostate cancer has been found to be much more sensitive to higher radiation doses than other cancer types, allowing you to safely receive higher doses over fewer visits.

The procedure will be conducted under general anesthesia, as up to 18 needles will be inserted through your perineum to reach your prostate. These needles are hollow, like a pipe, and will be used to insert a radioactive source into your prostate temporarily for approximately 10-15 minutes. While this may sound painful and scary, please be assured that you will not experience any pain or discomfort during the procedure itself due to the anesthesia.

Your doctor will use a template grid and image mapping to help plan and guide accurate placement of these needles. An ultrasound probe will be placed into your rectum to help guide this placement, and would be the fastest method to visually map the prostate. However, magnetic resonance imaging or computed tomography may still be used. A temporary catheter will also be inserted into your bladder through the penis to drain your urine during the procedure, and will be removed before the procedure is complete.

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During the treatment, your doctor will be able to control exactly where radiation is released and for how long. Compared to other radiation treatments delivered externally, this method allows for precise adjustment and customization of the radiation levels delivered to your tumor. Your doctor will then be able to maximize the dose delivered while still minimizing the impact on your healthy tissues.

You will likely be able to go home the day of your treatment and resume most normal activities the following day. However, some common side effects that you may experience include: increased urination, blood in your urine or pain and swelling around your genitals.

So far, most urinary side effects occur at a relatively low rate and tend to subside within a couple of weeks rather than the months needed for LDR brachytherapy. Serious complications requiring hospitalization are also rare.

A key highlight is that you will not be radioactive after your treatment, and will not need to worry about radiation precautions affecting your day-to-day life. For example, contact with your loved ones would be fine, while sexual activities can be resumed safely. You should note, however, that if your partner is able to conceive, you will need to use contraception for up to a year after treatment in case your sperm was damaged by radiation exposure.

Originally proposed in the 1990s, HDR brachytherapy is still relatively new in comparison to long-standing external radiation and LDR brachytherapy treatments. With recent technological improvements, clinicians may now begin to reconsider the role it plays in prostate cancer as a more convenient and safe treatment. If HDR brachytherapy is suggested to you, considering its low side-effect rate, lack of post-treatment radioactivity and convenience it brings, it may be a preferable option for you.