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.
Why patients choose us
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A named brachytherapy consultant, high case volume
Not a generalist. A clinical oncologist and urologist team who do HDR prostate implants weekly, in a centre set up for template-based transperineal implantation.
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MDT-led, before you commit
MRI, PSMA-PET where indicated, and an MDT decision on whether HDR monotherapy, HDR boost or another modality fits your risk group.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
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.
Indicative pricing
What private HDR prostate brachytherapy costs.
Indicative all-inclusive ranges across our partner centres. Send us your diagnosis and we quote firm figures across two or three options.
In short
HDR boost with external beam: £12,000–£22,000. HDR monotherapy: £18,000–£28,000.
| Pathway | Indicative range | Typical duration | Notes |
|---|---|---|---|
| MDT review and treatment planning consultation | £600–£1,200 | 45–60 min | 48 hours |
| HDR boost (single fraction) + external beam course | £12,000–£22,000 | 4–6 weeks | All-inclusive |
| HDR monotherapy (2 fractions, all-inclusive) | £18,000–£28,000 | 1–2 weeks | All-inclusive |
| HDR salvage after prior external beam | £20,000–£32,000 | 1–2 weeks | All-inclusive |
| Planning MRI (multiparametric prostate) | £650–£950 | 45 min | 48 hours |
| PSMA-PET/CT (if not already done) | £2,200–£3,000 | 90 min | 5 days |
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. We confirm a firm quote and insurer cover within one working day.
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.
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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.
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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.
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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.
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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.
The journey
From diagnosis to PSA follow-up, what happens, in order.
One team from first message to long-term follow-up, including your MDT recommendation and PSA surveillance plan.
Phase 1 · Before treatment
Concierge, off-stage for you
Phase 2 · Implant day
Overnight stay at the centre
Phase 3 · After
PSA follow-up, MDT review
- 01
Before
You send us the diagnosis
A short, confidential form. PSA, Gleason grade group, T-stage, MRI PI-RADS and any PSMA-PET result. We work from what you have.
- 02
Before
MDT recommendation within one working day
Whether HDR monotherapy, HDR boost with EBRT, LDR seeds, SBRT or surgery fits your risk group. Indicative price. An honest read either way.
- 03
Before
Planning MRI and consent
A dedicated planning MRI, consent with the clinical oncologist and urologist, hormone therapy started if indicated for high-risk disease.
- 04
Implant day
Admission and general anaesthetic
Same-day admission, GA, lithotomy position, transrectal ultrasound and template placement in the perineum.
- 05
Implant day
The HDR implant and treatment
15 to 20 thin plastic catheters placed transperineally under TRUS guidance. CT or MRI planning, then the iridium-192 source delivers dose robotically through each catheter for 15 to 19 minutes.
- 06
Implant day
Catheters removed, overnight stay
Catheters are removed the same day. Overnight stay for observation, a urinary catheter overnight, home the following morning.
- 07
After
PSA follow-up and MDT review
PSA at 6 weeks, 3 months and 6 monthly thereafter. MRI at 2 years. Long-term nadir often reached at 3 to 5 years.
Typical timing: MDT decision within 1 working day. Implant within 2–3 weeks. PSA nadir at 3–5 years.
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.
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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.
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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.
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Locally advanced disease with seminal vesicle involvement
Selected T3b cases where the catheter geometry can cover the base and seminal vesicles adequately, MDT-led.
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Salvage after prior external beam recurrence
Biopsy-proven, MRI or PSMA-PET localised recurrence within the prostate after prior radiotherapy, in select cases.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Robotic prostatectomy (compare)
Definitive surgical removal. A different balance of urinary, sexual and continence side effects to radiotherapy, and a clear pathological stage.
Where it is done
A small panel of UK centres that offer HDR prostate brachytherapy privately.
HDR prostate brachytherapy is a specialist service. In London and the South East the main private providers include the Royal Marsden Private Care, University College London Hospital Private, GenesisCare at Cromwell Hospital, Mount Vernon Private Care and HCA London Bridge. The Christie Private Care in Manchester covers the North.
Selection criteria
How we choose every centre we refer to.
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Clinical oncologists doing HDR prostate implants weekly, not occasionally
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Template-based transperineal implantation with TRUS or MRI fusion guidance
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Robotic afterloader (Elekta Flexitron or Varian Bravos) with 3D image-guided planning
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Full urology and clinical oncology MDT, including SBRT, LDR seeds and surgical options
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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 quiet reminder
Radiotherapy language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the plan before your consent appointment, just ask.
- 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.
- 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.
- 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.
- 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
Cover for HDR brachytherapy varies by insurer and by indication - usually funded when medically indicated. We confirm cover before booking.
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.
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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.
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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. We confirm cover in writing before you book.
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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.
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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.
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Do I need an MDT decision before booking?
Yes. Every case we arrange goes through a urology and clinical oncology MDT so the recommendation reflects the whole picture: MRI stage, PSMA-PET where available, Gleason grade group, PSA kinetics, gland volume, urinary symptoms and your own preferences. HDR is often the right answer, and sometimes it is not.
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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?
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LDR seed brachytherapy
Permanent iodine-125 seeds for low and favourable-intermediate risk.
Learn more -
Prostate SBRT (5 fractions)
Non-invasive stereotactic external beam in 5 sessions.
Learn more -
Proton beam therapy
External proton radiotherapy: the dose-distribution debate.
Learn more -
Robotic prostatectomy
Definitive surgical removal of the prostate.
Learn more -
MR-linac adaptive radiotherapy
Daily plan-of-the-day external beam on an MR-linac.
Learn more -
Prostate cancer overview
Diagnosis, staging and every treatment pathway in one place.
Learn more
Ready to talk?
Send us your diagnosis. We come back with an MDT-led recommendation within one working day.
HDR prostate brachytherapy is a specialist decision, and often it is not the only good answer. We match you to a named consultant, tell you what each pathway will cost and quietly stand aside if surgery, SBRT or LDR seeds fit you better.