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High Dose Rate Brachytherapy (HDR) refers to the insertion of hollow rods through the perineum (the area behind your scrotum) directly into the prostate. Radioactive wires are then placed down the hollow rods in order to direct a high dose of radiation directly into the prostate.

High dose rate brachytherapy differs from conventional external beam radiotherapy which travels through body tissue before reaching the prostate gland. High dose rate brachytherapy provides higher intensity, more localised radiation delivered directly to the prostate, and minimises the effects on the surrounding tissues such as the rectum and bladder. While long-term results are unknown at this time, current clinical data show good results up to ten years.

High dose rate brachytherapy rarely can be used in isolation but is usually combined with external beam radiotherapy. Often the high dose rate brachytherapy and external beam radiotherapy are also often combined with hormone therapy for a few months before the radiotherapy and up to 12 months after the radiotherapy. The exact timing of the external beam radiotherapy and the high dose rate brachytherapy are not important. The 2 treatments are separated by 10 days and it does not matter which treatment occurs first.
This procedure is performed in conjunction by Dr Swindle and Dr James McKean, a Radiation Oncologist.

Who is suitable for High Dose Rate Brachytherapy?

Patients with intermediate to high risk prostate cancer are suitable for high dose rate brachytherapy. In general patients that are suitable for high dose rate brachytherapy generally have one or more of the following characteristics:

• PSA > 10 at the time of diagnosis
• Gleason score > 7
• High clinical stage
• Multiple biopsies positive for cancer
• In addition, there are other criteria that patients must satisfy to be suitable. These criteria are not hard and fast and there is some leeway in these criteria.
• Prostate volume < than 45 mls. Larger prostates can cause technical problems with high dose rate brachytherapy and hormone therapy can help to shrink the size of the prostate prior to therapy
• IPSS (international prostate symptom score) score < 15 (men must not have difficulty in passing urine)
• UFR (urinary flow rate) > 15 mls per second
• Patients must not have a large middle lobe of the prostate (detected on cystoscopy)

Men who have a large middle lobe, difficulty passing urine with an IPSS score of >15 or a poor flow rate, can be made suitable for high dose rate brachytherapy by undergoing a minimal TURP.