What is brachytherapy?

Brachytherapy is a type of radiotherapy. It is given from inside of the body. There are two types of brachytherapy:

  • High dose rate brachytherapy – sometimes called temporary brachytherapy
  • Low dose rate brachytherapy – sometimes called permanent seed brachytherapy.
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LDR Brachytherapy

Important things to know

Who can have low dose rate brachytherapy?

You can have brachytherapy if: 

  • Your prostate cancer is contained within your prostate (localised or early stage), or
  • Your cancer has spread to the area just outside of the prostate (locally advanced).

What are the benefits of low dose rate brachytherapy?

  • There is usually only one treatment. So fewer visits to hospital than external radiotherapy
  • You can get back to work and normal activities quite quickly.

 

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Raymond
“I had never heard of brachytherapy until it was offered to me, but knowledge gets rid of the fear so gather as much information as you can.”
Raymond
Frequently asked questions (FAQs) about low dose rate brachytherapy
  • Radiation damages prostate cancer cells. Cancer cells are not able to repair themselves very well. So, radiation can stop them from growing.
  • In low dose rate brachytherapy , very small radioactive seeds are placed into your prostate. 
  • This means that the healthy cells around the prostate are less likely to get damaged. 
  • These seeds stay in your prostate forever. 

Pre-operative assessment

  • A few weeks before your brachytherapy you will have a pre-operative assessment. This will be at the hospital where you will be having your brachytherapy. You will:
    • Have blood tests
    • Have heart monitoring (an ECG)
    • Be weighed
    • Be told what you need to do to get ready for your brachytherapy.

 

Planning – the volume scan

  • Before you have low dose rate brachytherapy, you will need a volume scan. This is usually done at the same time as your treatment. But in some hospitals, you may have this done on a separate visit. Your doctor will give you more information.
  • During the volume scan an ultrasound probe is put into your rectum. This is used to build a picture of your prostate.  This helps your doctor to:
    • Measure the size (volume) of your prostate
    • Decide where the seeds need to go
    • Decide how many seeds you will need
    • helps to reduce the chance of infection. 
  • hormone therapy injectionsIf your prostate is too big, you may have to have a course of hormone therapy for three-to-six months before the seed implant. This will help to shrink your prostate.
  • In low dose rate brachytherapy, very small radioactive seeds are placed into your prostate. These seeds will stay in your prostate forever. This is usually done under a general anaesthetic. 
  • Each seed is 4–5mm in length and only 0.5mm thick. This is about the size of a grain of rice. 

     

brachytherapy seeds against a 5 pence piece and ruler

 

  • An ultrasound probe is placed into your rectum. This helps the doctor to see your prostate. 
  • 15–30 small, tube-like needles are put through the skin between your scrotum and anus (perineum). 

     

Showing placement of seeds in prostate and urinary catheter

 

  • About 60–90 radioactive seeds are then put through the needles into your prostate. The needles are then removed. 
  • The whole operation takes about one–to-two hours. 
  • You will have a wound dressing on your perineum. This may feel a bit tight. It helps to reduce any bleeding or swelling. 
  • You may also have an ice bag between your legs. This also helps to reduce any swelling you may have. 
  • The radiation from the seeds lasts for about one year. Most of the radiation will happen over the first three months. 
  • The area between your back passage and testicles may feel a bit bruised and sore for a few days after your brachytherapy.
  • Having a poo may feel uncomfortable for a few days.
  • You will need to take time off work to go to your planning and treatment sessions.
  • You will be asked to take it easy for a few days after the treatment.
  • You should be able to get back to normal activities after about seven-to-10 days. Ask your doctor when you can go back to work and normal activities. 
  • Radiotherapy of any type can affect the amount and quality of your sperm.
  • It may mean that you will have problems getting someone pregnant.
  • If you think you may want children, please talk to your doctor before starting treatment.
  • You may be able to have some of your sperm saved and frozen. This is called sperm banking or sperm cryopreservation. You can learn more about sperm banking on the Human Fertilisation and Embryology Authority website (this link will open in a new external tab).
  • Cancer Research UK also have information about sperm collection and storage. For more information visit their website (this link will open in a new external tab).
Sperm banking
  • You may still be able to get someone pregnant.
  • There is a chance that the radiotherapy may damage your sperm. This may harm babies who are conceived during your treatment. So, you should use contraception during and after your course of radiotherapy
  • You should talk to your healthcare team for advice about safe sex during and after radiotherapy. 
  • You may also have problems getting and keeping an erection and painful erections. You can get more information about sexual problems from your healthcare team. 

Our services search tool will allow you to search for hospitals near you that offer low dose rate brachytherapy (the link will open in a new tab).
  

Things to know after low dose rate brachytherapy

precautions after low dose rate brachytherapy

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page.

What is risk?

  • Risk is the chance something bad could happen when we do something. Even simple things such as walking down the stairs can have risks. But we take risks because we think it will be worth it. We need to think about both the benefits and risks of what might happen when we do something.
  • You should always ask your healthcare team about both the benefits and risks of any treatment.
  • Remember if they tell you about a risk, it doesn‘t mean it will happen to you. They may say one man in ten who has this treatment will have a side effect. But they can‘t tell you if you will be the ‘one’ man who gets this side effect.
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Risk vs Benefit

Very common side effects

Affects MORE THAN

1 in 10 mwn
Physical

Physical

  • Bruising and discolouration of the skin between your back passage and testicles (perineum)
  • Problems peeing.
Sexual interest

Sexual

  • Problems getting and keeping an erection.

Common side effects

Affects UP TO

1 in 10 mwn

Physical

Physical

  • Discomfort in the back passage
  • Slime (mucous) coming from the back passage
  • Unable to hold your pee
  • Infection in your pee that needs §antibiotics
  • The need for surgery if you have ongoing problems passing pee
  • Need for other treatments, e.g. surgery or hormone therapy, if your cancer does not completely go away.
  • The information on the risks comes from the British Association of Urological Surgeons (BAUS). You can access their leaflet about low dose rate brachytherapy on the BAUS website (this link will open in a new external tab. Please note, the leaflet is produced by BAUS and is in PDF format. It may not be compatible with screen readers).
  • There may be local data from your area. You can ask your healthcare team if they have this information too. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page.

What is the impact?

  • We asked real visitors to the infopool to share their experience of this treatment. They told us how this treatment had impacted their everyday lives in a number of different areas.
  • The numbers and images below represent how many people said this treatment had impacted them 'a lot' in each of the different areas.
  • For example, imagine it says ‘25 in 100’ underneath ‘physical and social wellbeing’. This means that 25 out of 100 people who shared their experience of this treatment told us it impacted their ‘physical and social wellbeing’ a lot. However it would also mean that 75 out of 100 people said it had not impacted them a lot.

Physical and social wellbeing

Enjoying activities such as walking or going out to the pub

74 out of 100

Effect on relationships

Ability to make good connections with others

43 out of 100

Sexual activity

Ability to reach sexual arousal, either physically or emotionally

71 out of 100

Sense of self

Knowing who you are and what motivates you

34 out of 100

Wellbeing and quality of life

Feeling good and functioning well in your personal and professional life

57 out of 100

Mental and emotional health

Ability to think clearly, make good decisions, and cope with your emotions

31 out of 100

Fatigue

Feeling of constant physical and/or mental tiredness or weakness

66 out of 100