What is LDR brachytherapy?

LDR brachytherapy is a targeted form of internal radiotherapy for prostate cancer and an effective, minimally invasive treatment appropriate for many men. It has significant quality of life benefits over alternative treatments such as surgery and external radiotherapy. In addition to offering significantly improved outcomes regarding both sexual function and incontinence, according to data from the Prostate Cancer Results Study Group, LDR brachytherapy achieves >90% of patients disease-free at over 10 years and unlike with surgery, <1% ever need to have further treatment such as a radical prostatectomy.

Patients with suspected prostate cancer are usually referred by their GP to a surgeon. Some may be guided towards surgery to fully remove the prostate and/or external radiotherapy, which may mean taking weeks out of ‘normal life’ and can permanently damage sexual and bladder function.

The type of treatment you will be offered depends on the size of your prostate, the stage of your cancer, your Gleason score and PSA level, however it’s important to understand all your options

Please click to listen to Dr Stephen Bourne discuss why Australian patients should consider LDR Brachytherapy.

Many patients are suitable for LDR brachytherapy, a quick treatment with a much lower risk of sexual and urinary continence problems than other treatment options. However, LDR brachytherapy is frequently overlooked as a treatment, because they are unaware of the option. Not all prostate cancer centres offer LDR brachytherapy, although the treatment may be available at an alternative location. Again, it’s important to ask about all treatment options before making a decision.

About LDR brachytherapy

Low dose-rate brachytherapy (seed implantation) is a type of internal radiotherapy for prostate cancer. It is targeted at the site of the tumour so the radiation kills the cancer cells minimising damage to surrounding healthy cells. It is not major surgery and usually you will only spend 1 day in hospital. Generally LDR brachytherapy has a low complication rate, and most men return to their usual pre-treatment activities within a couple of days.

Also known as Prostate brachytherapy, (LDR brachytherapy is different from External Beam Radiotherapy (EBRT), which uses x-rays beamed into the tumour site from outside the body. In EBRT the x-rays have to pass through other body tissues before reaching the tumour site, which means that the healthy parts of the body around the tumour may also be affected (see Figure 2, below).

Radiotherapy infographic

By contrast LDR brachytherapy involves inserting tiny radioactive capsules or seeds directly into the prostate gland through fine needles. Each seed is the size of a grain of rice, and between 80-120 seeds will be used, depending on the size of the prostate and the tumour location. Figure 3 (above) shows the size of the seeds and needles used. Figure 4 (above) shows an illustration of how the needles are guided using a grid for precision and accuracy.

Radiation released from the brachytherapy seeds accurately targets the tumour, destroying the cancer cells. The seeds are positioned close to the tumour and because the radiation doesn’t spread more than a few millimetres from each seed there is minimal or limited damage to any other non-cancerous or healthy tissue, such as the urethra (the tube through which urine passes), bladder and rectum. The seeds release most of their radiation over the first few months after being inserted. 

LDR brachytherapy is said to be more ‘targeted’ than conventional (external) beam radiotherapy, and it has a lower incidence of severe side effects. Figure 5 (above) shows an illustration of the seeds in position.

Unlike other forms of radiotherapy, LDR brachytherapy is a much faster and more convenient procedure. It is often a same-day procedure carried out in the radiotherapy department of the hospital under general anaesthetic, but occasionally may involve an overnight stay. Patients can usually return to levels of pre-treatment activities within a couple of days of having LDR brachytherapy. Please click here for real-life case studies from LDR Brachytherapy patients.

LDR brachytherapy procedure

A patient referred for LDR brachytherapy will first attend an appointment with the oncologist for treatment planning. The timing of this varies from hospital to hospital and could be as long as two weeks before the procedure or in some centres, immediately before treatment delivery

At the planning stage ultrasound, or magnetic resonance imaging (MRI) scanning of the prostate, helps the clinicians to map the exact position of the tumour and the prostatic anatomy to plan the appropriate radiation dose.

At the time of the procedure, the patient will have a general or spinal anaesthetic. Tiny radioactive ‘seeds’ about the size of a grain of rice are inserted into the prostate using hollow needles that allow accurate positioning according to the plan. Ultrasound is usually used to guide the needles to deliver the radioactive seeds through the perineum, the area of skin between the scrotum and the anus. After they have delivered the seeds, the needles are then removed.

The LDR brachytherapy procedure usually takes just one hour and after having time to recover from the anaesthetic, most patients return home the same day. A CT scan is usually performed within the first 4 weeks to obtain further planning information.  The seeds remain in place, emitting most of the therapeutic radiation over a period of months. This approach destroys the tumour with minimum damage to the surrounding healthy tissue and in a way which is least disruptive to ‘normal’ life.

After treatment, the patient will return periodically for monitoring of the treatment progress and prostate cancer tumour reduction.

Elderly man sat outside in a meadow

Radiotherapy for cancer treatment

Brachytherapy is a type of radiotherapy which is used to treat many different cancers by destroying the cancer cells with internal radiation. In low dose-rate (LDR) brachytherapy, the radioactive seeds remain in place. It is sometimes also called ‘internal radiotherapy’ or ‘permanent seed brachytherapy’. High dose-rate (HDR) brachytherapy involves the temporary placement of much stronger radioactive sources in the prostate over a series of procedures.

Another commonly used radiotherapy treatment is External Beam Radiotherapy (EBRT), which delivers the radiation from the outside.

Treatments choices for cancer ultimately depend on the type and location of cancer as well as patient preferences. Options are usually discussed with the specialist to which a patient is referred to find the best solution for that individual. It’s important to speak to multiple specialists, if possible, and to consider all your options and their potential side effects before deciding on your treatment.

Radiotherapy may be used in combination with other treatments such as hormone therapy and surgery.

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