Brachytherapy is a type of radiotherapy in which radiation is delivered from inside or very close to the prostate. It can be an option for some people with localised or locally advanced prostate cancer, either on its own or combined with external beam radiotherapy depending on the cancer risk group and individual circumstances.
Your specialist team will consider factors such as the stage and risk of the cancer, the size of your prostate, urinary symptoms, your general health and other treatment options before recommending brachytherapy.
Low-dose-rate (LDR) brachytherapy
Low-dose-rate brachytherapy is sometimes called permanent seed brachytherapy. Small radioactive seeds are inserted into the prostate through needles, usually under anaesthetic and with imaging guidance.
The seeds remain permanently in the prostate but gradually give off lower-dose radiation over a period of weeks or months. The radiation becomes weaker with time.
Read NICE information about low-dose-rate brachytherapy.
High-dose-rate (HDR) brachytherapy
High-dose-rate brachytherapy uses temporary tubes or applicators placed into the prostate. A radioactive source passes through them for a controlled period to deliver a high dose of radiation directly to the prostate. The radioactive source and applicators are then removed, so no radioactive material is left permanently in the body.
HDR brachytherapy may be used in combination with external beam radiotherapy for some people with localised or locally advanced prostate cancer.
Brachytherapy with external beam radiotherapy
NICE recommends considering brachytherapy combined with external beam radiotherapy for people in several localised and locally advanced prostate cancer risk groups. Brachytherapy alone is not recommended for the highest-risk localised or locally advanced groups.
See our Radiotherapy page for more information about external beam radiotherapy.
Read NICE recommendations on prostate cancer treatment.
Possible side effects
Side effects vary according to the type of brachytherapy and the individual. Your treatment team will explain the effects most relevant to you.
Possible effects can include:
- needing to urinate more often or urgently
- difficulty or discomfort when urinating
- a weaker urine flow
- blood in the urine or semen for a short period after treatment
- bowel or rectal symptoms
- erectile dysfunction, which can sometimes develop gradually
- tiredness
Some urinary symptoms can temporarily become worse after brachytherapy. A small number of people may have difficulty passing urine and require a catheter. Your specialist team can explain the likelihood of these effects in your circumstances and how they can be managed.
Radiation precautions after LDR brachytherapy
Because LDR seeds remain in the prostate for a period while they lose their radioactivity, your treatment centre may give you temporary precautions about close contact with pregnant people or young children. Follow the specific instructions provided by your radiotherapy team.
HDR brachytherapy does not leave radioactive material inside the body after the treatment session.
Monitoring after treatment
You will have follow-up appointments and PSA blood tests after brachytherapy to monitor how the prostate cancer is responding. PSA usually falls gradually rather than immediately after radiotherapy.
Questions to ask your specialist
- Is brachytherapy suitable for my type of prostate cancer?
- Would I have LDR or HDR brachytherapy, and why?
- Would I also need external beam radiotherapy or hormone therapy?
- What urinary, bowel and sexual side effects are most likely for me?
- What radiation precautions will I need to follow?
- What other treatment options are suitable for me?
This information provides a general introduction to brachytherapy for prostate cancer and does not replace advice from your oncologist, urologist or specialist cancer team.