High dose-rate (HDR) brachytherapy, also known as temporary brachytherapy, is a form of internal radiotherapy used to treat prostate cancer. It involves inserting thin tubes into the prostate, through which a high-dose radiation source is passed to target and destroy cancer cells. The radiation remains in the body for only a few minutes, then is completely removed, leaving no radioactive material behind.

Because the radiation is delivered directly to the prostate, nearby healthy tissue receives a significantly lower dose compared to external beam radiotherapy (EBRT). This reduces the risk of damage to surrounding organs.

HDR brachytherapy may be given:

  • On its own (less common)
  • In combination with EBRT (more common), often alongside hormone therapy

Another internal radiation technique, permanent seed brachytherapy or low dose-rate brachytherapy (LDR), involves implanting radioactive seeds that remain in the prostate over time.

Who Can Have HDR Brachytherapy?

HDR Brachytherapy Alone

A limited number of facilities offer HDR brachytherapy on its own for men with localised prostate cancer (cancer confined to the prostate) that is considered low or medium risk.

HDR Brachytherapy with Other Treatments

Most often, HDR brachytherapy is used in combination with EBRT for:

  • Localised prostate cancer
  • Locally advanced prostate cancer (spread just outside the prostate)

It may also be used as salvage therapy—to treat prostate cancer that has returned after previous radiotherapy.

HDR brachytherapy is not typically used to treat advanced prostate cancer that has spread to distant parts of the body.

Who May Not Be Suitable?

HDR brachytherapy may not be appropriate if you:

  • Have severe urinary symptoms (e.g., weak flow, incomplete bladder emptying), as these can worsen post-treatment.
  • Recently had a TURP procedure (Transurethral Resection of the Prostate) — some hospitals require a 3–6 month wait or may not offer HDR after TURP due to increased risk of urinary side effects.
  • Are unable to have a general or spinal anaesthetic due to other health issues.

Advantages and Disadvantages

Advantages

  • High precision radiation targets the prostate, sparing nearby healthy tissue.
  • Typically a short hospital stay.
  • Quick recovery—most return to normal activities within a week.
  • Can be used again with hormone therapy if cancer recurs.
  • When combined with EBRT, provides a radiation “boost” to enhance cancer control.

Disadvantages

  • May cause urinary, bowel, and sexual side effects.
  • Requires anaesthesia, which carries its own risks.
  • Some hospitals require multiple treatments and prolonged periods lying still with tubes in place—this can be uncomfortable.
  • It may take time to know whether the treatment was successful.

The Treatment Process

Before Treatment

  • You may receive hormone therapy for 3–6 months prior, especially if your prostate is large or your cancer is high risk.
  • On the day of treatment:
    • You will have an enema to empty your bowels.
    • A general or spinal anaesthetic will be administered.
    • An ultrasound probe is inserted rectally to guide tube placement.
    • 10–20 thin tubes are inserted through the perineum (between the testicles and anus) into the prostate.
    • A catheter is inserted to drain urine.
    • Imaging (CT, MRI, or ultrasound) is used to plan the precise radiation dose.

During Treatment

  • The tubes are connected to a brachytherapy machine.
  • A radioactive source is inserted into each tube for a few minutes.
  • The radiation source is then removed automatically.

You may have:

  • One treatment (tubes removed immediately after)
  • Two or three treatments (with a gap of at least six hours between), depending on your hospital’s protocol.

Some hospitals keep the tubes in between sessions (requiring you to stay still), while others reinsert them before each treatment.

After Treatment

  • The catheter is removed once bleeding has settled.
  • You may be discharged the same day or stay overnight.
  • Common short-term side effects include:
    • Blood in the urine
    • Perineal discomfort or bruising
    • Mild bowel discomfort

You’ll be given medications such as antibiotics, pain relief, and drugs to ease urination.

You will not be radioactive after treatment, and it is safe to be around others, including children and pregnant women.

If you’re also having EBRT, this usually starts around two weeks after HDR brachytherapy.