The difference between LDR and HDR brachytherapy: Comparing Prostate Cancer Treatments

Prostate Cancer is the most common cancer in men in the UK, with about 1 in 8 men getting prostate cancer in their lifetime. On average, over 52,000 men are diagnosed with prostate cancer every year. Yet, if caught early, prostate cancer has a good survival rate – around 475,000 men in the UK are either living with, or after, prostate cancer. There are a number of treatment options available to men, from no intervention (active surveillance) to full removal of the prostate (radical prostatectomy). In between, there are also a range of less invasive treatments men may be offered, or may wish to seek out. Here, we explore two of those: low-dose rate (LDR) brachytherapy and high-dose rate (HDR) brachytherapy.

What is Brachytherapy?

Brachytherapy is a form of internal radiotherapy, or radiation therapy, an effective form of treatment that kills prostate cancer cells by using high energy rays or particles.

Brachytherapy treatment is a highly targeted, or focal, therapy that can be used to treat both early- to middle-stage prostate cancer, where the cancer is contained within the prostate gland and / or where it may have spread slightly beyond the prostate.

It can be used as a standalone treatment, or in conjunction with other treatments such as hormone deprivation and External Beam Radiotherapy (EBRT). And it may be used to treat men with limited, slow-growth prostate cancer to reduce the size of the tumour and improve survival and overall quality of life.

Read more here for more information comparing EBRT to brachytherapy treatments [link to previous article].

Low-Dose Rate Brachytherapy

As mentioned, there are two types of brachytherapy and it is important to understand the difference between LDR and HDR brachytherapy. With low-dose rate brachytherapy (also known as permanent brachytherapy), your consultant will insert a number of tiny seeds – about the size of a grain of sand – precisely around the cancer cells. Over a period of approximately six months, these seeds will slowly emit a dose of radiation to kill off the cancer cells. Because the radiation doesn’t spread more than a millimetre or so from each seed, there is minimal damage to the surrounding healthy tissue, reducing the potential side effects compared with EBRT and other treatment options, including HDR-B. 

Low-dose rate brachytherapy is typically a same-day procedure, though depending on the time of the treatment an overnight stay may be necessary. Recovery is quick and men normally return to normal activities within a week.

For more information on low-dose rate brachytherapy and patient stories, click here.

High-Dose Rate Brachytherapy

In high-dose rate brachytherapy (HDR-B or temporary brachytherapy), thin tubes are inserted into the prostate aligned to the location of the tumour. A source of radiation is passed through the tubes for a few minutes in high intensity (hence the name) to destroy the cells. The tubes are then removed, along with the source of radiation.

The total dose of radiation may be delivered as one treatment or – more commonly – divided over two or more treatments, called fractions. Typically, men are in hospital for one or two days for treatment; as with LDR-B recovery is quick so you can return to normal activities within a week.

More information can be found here.

In both cases, LDR and HDR brachytheraphy, due to the fact that you are receiving surgery in a very sensitive part of the body, some men may experience side-effects such as urinary, bowel or erection problems. However, many men experience no long-term issues at all.

Outcomes & Combined Treatments

While clinical evidence suggests minimal superiority of multi-fraction HDR or LDR brachytherapy with respect to tumour control or reduced toxicity, a recent study has raised some concerns over one type of HDR-B treatment. Evidence suggests that single fraction HDR-B with a radiation dose of 19 Gy should not be used to treat low or intermediate-risk prostate cancer, with patterns of local relapse apparent.

In addition, evidence from Leeds Teaching Hospitals NHS Trust indicates that LDR-B has a significantly better relapse and serious adverse event profile than HDR-B when combined with External Beam Radiation Therapy (EBRT).

It’s important to consider the potential side effects and outcomes of any cancer treatment, and it is always advisable to speak with your consultant or specialist nurse to get a full picture of what is available to you. We encourage all men and their families to discuss all their treatment options before deciding, however difficult it may seem.