Brachytherapy

What is Brachytherapy?

Brachytherapy is a form of internal radiotherapy used to treat prostate cancer. Tiny radioactive seeds containing Iodine-125 are permanently implanted into the prostate gland. These seeds deliver a high dose of radiation directly to the cancerous tissue, minimising exposure to surrounding organs such as the bladder and rectum. The seeds become inactive after approximately nine months. Our LDR brachytherapy technique uses real-time imaging and planning to ensure precise seed placement, optimising treatment outcomes and reducing side effects.

Is brachytherapy right for me?

Brachytherapy is most suitable for patients with early-stage prostate cancer that is confined to the gland. Ideal patients typically have:

• PSA levels below 25 ng/ml
• Cancer stage T1 or T2
• Gleason score of 8 or less
• No severe urinary symptoms
• A prostate size under 60cc

Patients with larger prostates may require hormone therapy to reduce gland size before treatment. A detailed assessment with our clinical team will determine your suitability.

How to prepare for Brachytherapy

Before the procedure, you’ll attend an outpatient assessment, including:

• Medical history review
• Rectal examination
• Transrectal ultrasound (TRUS)
• Urinary flow and bladder scan
• Symptom questionnaire

If suitable, your treatment will be scheduled. Bowel preparation is required the day before the procedure using Picolax powder, and you’ll be advised to stay well hydrated.

What happens during brachytherapy?

The procedure is performed under general anaesthesia. Using ultrasound guidance, radioactive seeds are inserted into the prostate via needles passed through the perineum. Around 60–120 seeds are placed using 20–30 needles. A catheter is inserted during the procedure and removed after a post-operative CT scan confirms seed placement.

After the procedure

You may experience mild bruising and tenderness. Some discomfort during urination is common. Your urine will be filtered to catch any loose seeds, though this is rare. Most patients are discharged once they can urinate comfortably.

Recovery after Brachytherapy

Recovery is typically quick. You can resume normal activities within a few days, but avoid heavy lifting for two weeks and cycling for 2–3 months. Urinary symptoms may worsen temporarily, peaking around 4–6 weeks, and usually resolve within 6–9 months. You’ll be prescribed:

• Alpha-blockers (e.g. tamsulosin)
• Antibiotics
• Laxatives

Follow-up includes regular PSA checks starting three months post-treatment.

What are the benefits of Brachytherapy?

• Highly effective for early-stage prostate cancer
• Minimally invasive with a short hospital stay
• Lower risk of urinary incontinence (<1%)
• Reduced risk of erectile dysfunction compared to surgery
• Faster return to normal activities

What are the risks of Brachytherapy?

• Temporary urinary symptoms (frequency, urgency, weak stream)
• Rare urinary retention (may require short-term catheter use)
• Mild bowel changes (constipation or diarrhoea)
• Erectile dysfunction in ~20% of patients
• Temporary PSA “bounce” in some cases

Radiation precautions are advised for two months post-treatment, especially around pregnant women and small children.

Are there alternatives to Brachytherapy?

If brachytherapy isn’t suitable, other treatment options may include:

• External beam radiotherapy
• Radical prostatectomy (surgery)
• Cryotherapy
• High-intensity focused ultrasound (HIFU)

Your consultant will discuss the most appropriate treatment based on your individual case.