LDR Brachytherapy for Prostate Cancer

LDR brachytherapy (also known as low-dose rate brachytherapy) is a minimally invasive, highly successful treatment for prostate cancer that has been established for over two decades. If you, or a loved one, have recently been diagnosed with prostate cancer and want to learn more about LDR brachytherapy as a treatment option, read on.

Before settling on a treatment for prostate cancer, it is important to consider the full range of options – including those that may not have been mentioned initially by your hospital or treatment centre. When caught early, prostate cancer has a good survival rate – around 475,000 men in the UK are either living with, or after, prostate cancer – so it is worth taking some time to understand the potential medium- to long-term impact of your treatment on your lifestyle.

In choosing your treatment option, there are two main things to consider. The first is the success rate of the treatment given, in terms of both recurrence-free or overall survival (OS) – i.e. the cancer doesn’t return – and in terms of biochemical failure (PSA levels that don’t increase again over time). The second is the potential side-effects or implications of the treatment on your lifestyle.

Here, we take a look at what LDR brachytherapy is, as well as what to expect from the treatment.

What is LDR Brachytherapy?

LDR 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.

It 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.


The Procedure

With LDR 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 other treatment options, including HDR or high-dose brachytherapy[1] .

LDR 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.


Some men can experience some pain or swelling in the perineum after brachytherapy. This is typically short-lived and can be relieved through applying ice packs and / or pain medication. Some men may also have some discomfort urinating and need to urinate more often. Again, most men find that these symptoms lessen after the first couple of weeks and medication can help. Some may also experience increased levels of tiredness in the short term post-treatment.

Side Effects and Success Rates

Most men find LDR brachytherapy a highly effective treatment option that allows them to carry on with their everyday lives as well as (if not better than) they did before their prostate cancer diagnosis.


From men who enjoy walking; motorcycle riding; even ukulele playing, there is little to suggest that brachytherapy has an adverse reaction on men’s hobbies and their overall lifestyle.
Read some patient stories here.

LDR brachytherapy can also be a suitable treatment for any patient, irrespective of age and the risk-grade of their cancer diagnosis. Despite active surveillance being the default position for low-risk cancer, as many as 70% of younger patients treated for prostate cancer receive radical prostatectomy. The quality of life and patient experience implications are significant.

Indeed, a recent study published in the New England Journal of Medicine[1] revealed that surgery to remove the prostate has the greatest impact on sexual function and urinary continence compared to other treatments. In contrast, LDR brachytherapy has a rich and growing evidence base of long-term outcomes[2] .

Where it’s appropriate, the patient experience benefits make LDR brachytherapy an attractive option for younger patients. Studies show that the risk of incontinence after brachytherapy is far lower than in surgery and radiation[2]. It’s also associated with shorter recovery times and reduced overall treatment time – making it less disruptive for younger patients.

In addition, further independent studies show that LDR brachytherapy is a highly viable option for not just low-risk prostate cancer, but also intermediate- and high-risk.[3] 

Conclusion

The majority of men diagnosed with prostate cancer will only get advice on a couple of treatment options, with the majority being recommended radical surgery – despite its known side effects. Yet, LDR brachytherapy is a long-standing, proven treatment that is a highly viable – yet often discounted – option for many men.

It is, therefore, 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.


ENDS


[1] Donovan JL, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer, N Engl J Med 2016;375:1425-37. DOI:10.1056/NEJMoa1606221

[2] Buron C, Le Vu B, Cosset JM et al. Brachytherapy versus prostatectomy in localized prostate cancer: results of a French multicenter prospective medico‐economic study. Int J Radiat Oncol Biol Phys 2007; 67: 812–22