What is high dose rate prostate brachytherapy (HDR)?
High dose rate brachytherapy (HDR) is a temporary implant where hollow needles are placed in the prostate under general anaesthetic to direct a radioactive treatment source into the prostate gland. This is a small radioactive iridium source mounted on the end of a cable. The machine will automatically remove the radioactive source when the treatment is finished. You are not radioactive once the source is removed.
After the treatment, the needles are removed from the prostate while you are still under anaesthetic.
The standard combined treatment is:
Hormone treatment and brachytherapy HDR implant treatment followed by external beam radiotherapy given daily for 15 days on weekdays only - as an outpatient. The course will usually begin 2 weeks after the brachytherapy and will include a visit for a CT planning scan as an outpatient beforehand. The scan and the images are used to guide the treatment and are not used for diagnostic purposes.
HDR alone. In a very selected group of men, for example, those who have previously had external beam radiotherapy to the prostate, HDR brachytherapy can be used to treat local recurrence.
What are the benefits of treatment?
HDR brachytherapy is a way of delivering a relatively high dose of targeted radiotherapy to the prostate gland whilst minimising the dose to the surrounding normal tissues such as bowel and bladder.
Are there any alternatives to this treatment?
High doses of radiotherapy may also be delivered from the outside without additional HDR brachytherapy. Your oncologist will talk through these options and suggest which treatment is best for you.
What will happen during the implant?
You will need to attend a pre-assessment clinic as an outpatient before the implant. This will include an ECG [tracing of your heart] and some blood tests in preparation for your treatment. You may drive yourself to this appointment.
You will be admitted to The Christie on the morning of the treatment. We will inform you before you come to The Christie what time you need to stop eating and drinking before your general anaesthetic. You will remain in hospital overnight afterwards.
You will have an enema on arrival on the ward to clear the lower part of the bowel. Your anaesthetist will see you and this is an opportunity for you to ask any questions. You will be taken to the brachytherapy theatre and be given a general anaesthetic. While under anaesthetic a catheter will be inserted through the penis to drain urine from your bladder. Then fine hollow metal needles will be passed through the skin between your scrotum and anus [perineum] into the prostate gland, guided by an ultrasound probe inside your back passage.
Once the oncologist is satisfied with the needle positions, the treatment will be planned and you will receive your HDR brachytherapy treatment whilst asleep.
You will be connected to a machine in theatre and a very small radioactive source will travel by remote control from the machine into each of the needles in turn. The source will stay in each needle for a precisely calculated length of time, according to the treatment plan.
The machine will automatically remove the radioactive pellet when the treatment is finished. You are not radioactive once the pellet is removed. After the treatment the needles will be removed before you awake. In all, the procedure will involve an anaesthetic time of around 3 hours and you will then be in the recovery area for a while afterwards.
When you are fully awake, you will leave the theatre recovery area and return to the ward. When you are on the ward we will give you painkillers if you need them, however, most patients do not experience very much discomfort at all.
The catheter draining urine from your bladder will be removed once you are up and moving about on the ward. This is usually early the next morning. You may pass small amounts of blood in your urine for a few days after the procedure. There is no need to worry as this is quite usual. We like you to remain on the ward until you can pass urine easily.
What happens after the brachytherapy is completed?
The area where the implant was placed may feel a little uncomfortable for a few days, particularly if you sit on a hard chair.
Sometimes bowel movements may feel a little uncomfortable for a few days and may occasionally cause a sharp pain in that area. This will settle on its own and is rarely severe enough to need active treatment. You can soon return to your normal level of activity. We will send you home with some medication to help you pass urine more easily.
You will find dietary advice in another booklet called 'Radiotherapy to the prostate'. This information will help you prepare for your course of external beam which will start approximately 2 weeks later.