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Prostate radiotherapy · London

HDR prostate brachytherapy private in London.

High-dose-rate iridium-192 brachytherapy for intermediate and high-risk prostate cancer, delivered as monotherapy in 1 to 2 visits or as a boost after external beam radiotherapy. A named clinical oncologist, MDT-led, in a centre that does this weekly.

A stethoscope on a clinical desk

What HDR brachytherapy is

A temporary implant. A very high, very focused dose.

High-dose-rate (HDR) prostate brachytherapy is an internal radiotherapy technique. Under general anaesthetic, 15 to 20 thin plastic catheters are placed through the perineum (the skin between scrotum and anus) directly into the prostate, guided by transrectal ultrasound and a rigid template.

With the catheters in place, a planning CT or MRI is performed. A robotic afterloader then advances a single iridium-192 source down each catheter in turn, dwelling at pre-computed positions for pre-computed times. The whole treatment takes 15 to 19 minutes. The source retracts into the machine, the catheters are removed the same day, and you go home the following morning.

Because the source is inside the prostate, dose falls off with the inverse square of distance. That gives HDR the highest biologically effective dose of any external prostate radiotherapy technique, while keeping the rectum and urethra within tight constraints.

A UK brachytherapy suite set up for HDR prostate implantation

Indicative pricing

What private HDR prostate brachytherapy costs.

Indicative all-inclusive ranges across UK centres.

In short

HDR boost with external beam: £12,000–£22,000. HDR monotherapy: £18,000–£28,000.

Pathway Indicative range
MDT review and treatment planning consultation £600–£1,200
HDR boost (single fraction) + external beam course £12,000–£22,000
HDR monotherapy (2 fractions, all-inclusive) £18,000–£28,000
HDR salvage after prior external beam £20,000–£32,000
Planning MRI (multiparametric prostate) £650–£950
PSMA-PET/CT (if not already done) £2,200–£3,000

Prices vary by centre, by clinical oncologist, by whether external beam and hormone therapy are included in the package, and by risk group. Most PMI insurers fund HDR brachytherapy when medically indicated.

Advantages

Why HDR sits where it sits in the pathway.

The physical and biological reasons a clinical oncologist reaches for HDR rather than another modality.

  • The highest biologically effective dose

    The inverse-square fall-off from an internal source lets HDR push the biologically effective dose above what any external beam can safely reach. Higher BED means better local control, especially in high-risk disease.

  • Sharp fall-off protects rectum and urethra

    Because dose drops rapidly outside the prostate, the rectal wall a few millimetres away receives a small fraction of the target dose. The urethra is spared with dedicated dwell-time optimisation.

  • One or two visits, not four to eight weeks

    HDR monotherapy is delivered in 1 or 2 fractions. HDR boost adds one implant to a shortened external beam course. Compared with 20 to 39 external beam fractions, that is a very different logistical demand.

  • No radioactive sources left in the body

    Unlike LDR seeds, nothing radioactive stays inside you. No restrictions around children, partners or pregnant women, and no small risk of seed migration.

Indications

When HDR is the right call - and when it is not.

The risk groups and situations where HDR earns its place in the pathway, plus the practical exclusions that push us to another modality.

  • Intermediate-risk prostate cancer (monotherapy)

    Gleason 3+4 or 4+3, PSA under 20, T1c to T2b: HDR monotherapy at 27 Gy in 2 fractions or 19 Gy single fraction.

  • High-risk prostate cancer (HDR boost)

    Gleason 8 to 10, PSA over 20 or T3a to T3b: HDR boost of 15 Gy after 40 to 46 Gy external beam, plus hormone therapy.

  • Locally advanced disease with seminal vesicle involvement

    Selected T3b cases where the catheter geometry can cover the base and seminal vesicles adequately, MDT-led.

  • Salvage after prior external beam recurrence

    Biopsy-proven, MRI or PSMA-PET localised recurrence within the prostate after prior radiotherapy, in select cases.

  • Younger patients wanting dose escalation

    Where a biologically higher dose is desirable and the balance of urinary and sexual side effects has been discussed fully.

  • Prostate volume 20 to 60 cc without large median lobe

    The gland must be implantable: too small or too large, or a bulky median lobe, may push us toward SBRT instead.

  • Comorbidities making a long external beam course unattractive

    HDR monotherapy delivers curative dose in 1 to 2 visits, useful for patients who cannot commit to 4 to 8 weeks of daily EBRT.

  • Not usually a fit: severe LUTS, prior TURP defect, IBD

    Severe urinary symptoms (IPSS over 20), a large post-TURP cavity or active inflammatory bowel disease usually push us to a different modality.

Outcomes

What the trials and registries actually show.

Numbers vary by risk group and by centre. These are typical published 5-year outcomes that we use in MDT discussions.

  • High-risk with HDR boost

    5-year biochemical disease-free survival of 85 to 90 percent with HDR boost + EBRT + ADT. The ASCENDE-RT trial showed brachytherapy boost roughly doubled biochemical control versus dose-escalated external beam alone in high-risk disease.

  • Intermediate-risk monotherapy

    5-year bDFS of 90 to 95 percent for favourable and unfavourable intermediate-risk disease treated with HDR monotherapy in 1 or 2 fractions across published series.

  • Salvage after prior radiotherapy

    Selected salvage HDR series report 3-year biochemical control of 50 to 70 percent, with substantially lower incontinence and rectal-injury rates than salvage prostatectomy.

Options and comparisons

HDR sits inside a family of prostate-cancer treatments.

How HDR compares against LDR seeds, SBRT, robotic prostatectomy and proton beam. LDR uses permanent low-dose seeds for low-risk disease; HDR delivers a higher biological dose and covers intermediate to high-risk. SBRT is non-invasive 5-fraction external beam. Surgery is definitive removal with its own sequelae. The proton beam dose-distribution debate is unresolved in prostate cancer.

  • HDR monotherapy, 2 fractions

    27 Gy in 2 fractions of 13.5 Gy, delivered a week apart. Two admissions, curative for intermediate-risk disease, no external beam needed.

  • HDR monotherapy, single fraction

    19 Gy in one fraction, one admission, one implant. Convenient. Slightly higher biochemical relapse rate than the 2-fraction schedule per current evidence.

  • HDR boost with external beam

    15 Gy HDR boost after 40 to 46 Gy external beam, with 6 to 36 months of androgen deprivation. The high-risk standard supported by ASCENDE-RT.

  • HDR salvage after prior radiotherapy

    A focal or whole-gland HDR implant after biochemical recurrence following external beam. Fewer side effects than salvage prostatectomy in selected cases.

  • Focal HDR (partial gland)

    Investigational in most UK centres: treating only the MRI-visible lesion plus a margin, to spare urethra and neurovascular bundles. Trial or expert-panel only.

  • LDR seed brachytherapy (compare)

    Permanent iodine-125 or palladium-103 seeds for low-risk and favourable intermediate-risk disease. Different device, different biology, different aftercare.

  • SBRT (5-fraction stereotactic EBRT)

    Non-invasive external beam alternative delivering 36.25 Gy in 5 sessions over 1 to 2 weeks. No anaesthetic, no catheters, similar biochemical control.

  • Robotic prostatectomy (compare)

    Definitive surgical removal. A different balance of urinary, sexual and continence side effects to radiotherapy, and a clear pathological stage.

Side effects and recovery

What to expect afterwards - honestly.

HDR is well tolerated. The things worth planning for are the anaesthetic, the transient urinary irritation, the low long-term stricture and incontinence risks, and the impact on sexual function.

  • General anaesthetic and overnight stay

    GA for the implant (60 to 90 minutes in theatre), one overnight stay for observation and urinary catheter. Home the following morning.

  • Transient urinary irritation, 4 to 8 weeks

    Frequency, urgency, dysuria and weak flow are common in the first 4 to 8 weeks. Alpha-blockers, anti-inflammatories and reassurance usually see it through.

  • Urethral stricture, uncommon

    Around 2 to 5 percent late risk of a bulbomembranous or apical stricture, higher after HDR boost with EBRT. Managed with dilatation or optical urethrotomy.

  • Late urinary incontinence, under 5 percent

    True stress incontinence after HDR alone is rare (under 5 percent). Higher if you have had a prior TURP or salvage after external beam.

  • Erectile dysfunction, 30 to 50 percent at 3 years

    Rates similar to SBRT and lower than surgery. PDE5 inhibitors, vacuum devices or intracavernosal therapy are discussed early.

  • No radiation precautions after discharge

    The iridium-192 source leaves with the machine. Nothing radioactive remains in you: no restrictions around children, partners or pregnant women.

  • Rectal side effects, low

    Grade 2 or worse proctitis under 5 percent. The sharp dose fall-off of HDR spares the rectum better than external beam alone.

  • Red flags after discharge

    Heavy haematuria with clots, inability to pass urine, fever, severe perineal pain or a leg-swelling suggestive of DVT: call the unit or go to A&E the same day.

  • PSA nadir at 3 to 5 years

    PSA falls slowly after radiotherapy. A benign PSA bounce is common in the first 2 years. A true failure needs 2 rises above nadir plus 2 ng/mL (Phoenix criteria).

Reading your treatment plan

Your HDR plan in four parts. Read the last one first.

Whichever centre delivers it, the treatment letter from your clinical oncologist keeps to the same shape.

A UK clinical oncologist reviewing an HDR prostate brachytherapy plan

A quiet reminder

Radiotherapy language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Risk group, PSA and MRI stage

    Your NCCN or Cambridge risk group, pre-treatment PSA, Gleason grade group, T-stage from MRI, and PSMA-PET result if done.

  2. 02 Plan

    Dose, fractionation and target

    Prescription dose in Gy per fraction, number of fractions, whether HDR is monotherapy or a boost, and the CTV and OAR (urethra, rectum) constraints.

  3. 03 Delivery

    Implant details and dosimetry

    Number of catheters, TRUS or MRI planning image set, D90 to the prostate, urethral D0.1cc, rectal D2cc. Read the dosimetry: it predicts side effects.

  4. 04 Impression

    Hormone therapy and follow-up plan

    Read this first: duration of ADT (if any), when your next PSA is due, when MRI or PSMA-PET follow-up is scheduled, and the point of contact for symptoms.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for HDR brachytherapy varies by insurer and by indication - usually funded when medically indicated.

Frequently asked

Everything we get asked about HDR prostate brachytherapy.

Quick answers on radiation precautions, insurance cover, sexual function, MDT process and PSA follow-up.

  • Am I radioactive after HDR brachytherapy?

    No. The iridium-192 source is loaded robotically into the catheters for 15 to 19 minutes, then withdrawn back into the machine. When you leave hospital there is nothing radioactive left in you: no restrictions around children, partners, pregnant women or pets. This is the main difference from LDR seed brachytherapy, where permanent seeds do give off low-level radiation for a few months.

  • Will my UK private medical insurance cover HDR prostate brachytherapy?

    Most major insurers (Bupa, AXA Health, Vitality, Aviva, WPA, Cigna) fund HDR brachytherapy when it is medically indicated and provided at a recognised centre. High-risk boost with EBRT and ADT is usually approved without difficulty. HDR monotherapy is increasingly funded for favourable intermediate-risk disease.

  • What is the effect on erections and sexual function?

    Erectile function typically declines gradually after any prostate radiotherapy. At 3 years, 30 to 50 percent of previously potent men have some new erectile difficulty after HDR, similar to SBRT and better than radical prostatectomy. Ejaculate volume falls and most men experience dry ejaculation. Fertility is affected and sperm banking is discussed before treatment if relevant.

  • Can HDR brachytherapy be repeated?

    Yes. HDR monotherapy is typically delivered in one or two fractions. Salvage HDR after prior external beam failure is possible in selected cases with biopsy-proven, MRI or PSMA-PET localised recurrence, and gives better toxicity profiles than salvage prostatectomy. A second HDR implant after a first HDR course is uncommon and MDT-led.

  • Do I need an MDT decision before booking?

    Yes. HDR is often the right answer, and sometimes it is not.

  • What PSA nadir should I expect and when?

    PSA falls slowly after brachytherapy. Most men reach nadir between 3 and 5 years, and a nadir under 0.5 ng/mL predicts durable control. A transient benign PSA bounce (a rise then fall) is common at 12 to 24 months and does not mean failure. True biochemical failure is defined as two consecutive rises 2 ng/mL above nadir (Phoenix criteria).

Related treatments

Looking at the alternatives?