Skip to main content

Prostate cancer · London and UK

LDR seed brachytherapy - private in London.

A single day-case treatment for localised prostate cancer - 60 to 120 permanent iodine-125 seeds implanted through the perineum, delivering the entire radiotherapy dose slowly over 6 to 9 months. Home the same day.

A stethoscope on a clinical desk

Indicative pricing

What private LDR seed brachytherapy costs in the UK.

Indicative ranges across UK centres.

In short

A private LDR seed implant in London: £15,000-£24,000, home the same day.

Stage Indicative range
Consultation and MDT review of your case £300-£550
Planning mpMRI and cystoscopy work-up £900-£1,600
LDR seed brachytherapy (iodine-125, day-case) £15,000-£22,000
LDR with palladium-103 seeds (selected centres) £17,000-£24,000
Post-implant CT dosimetry at 4-6 weeks £450-£800
Second-opinion review of MDT letter and imaging £250-£450

Prices vary by centre, by isotope (iodine-125 or palladium-103), by the number of seeds needed for your prostate volume, and by whether any inpatient stay is included.

What it is

Permanent seeds, delivered in a single day.

Low dose rate brachytherapy places tiny radioactive seeds inside the prostate. They stay in place for life and give up their dose slowly, over months, from within a few millimetres of the cancer.

  • Between 60 and 120 seeds

    Each seed is about the size of a grain of rice, sealed in titanium, and holds a small amount of iodine-125 or palladium-103.

  • Placed under TRUS and template guidance

    A perineal template and a transrectal ultrasound probe let the oncologist and physicist steer 20 to 30 needles into precisely planned positions.

  • Dose delivered over 6 to 9 months

    Iodine-125 has a 60-day half-life, so most of the dose is deposited in the first six months. After roughly a year the seeds are effectively inert.

When it helps

When LDR is the right choice - and when it is not.

The risk groups and prostate profiles where LDR shines, plus the anatomy and disease features that push us towards SBRT, HDR, surgery or a combined approach.

  • Low-risk prostate cancer (Gleason 3+3)

    Localised disease, PSA under 10, Gleason grade group 1. NICE-approved monotherapy where LDR gives excellent long-term control.

  • Favourable intermediate-risk (3+4)

    Selected Gleason 3+4, low percentage of pattern 4, PSA under 15. LDR as monotherapy in the right anatomy, or combined with a short EBRT boost.

  • Small to medium prostate under 60cc

    Ideal glands are 20 to 55cc. Larger prostates get pubic-arch interference and dose to the urethra, so downsizing is discussed first.

  • Mild urinary symptoms (IPSS under 15)

    A well-emptying bladder and a modest IPSS predict a smoother recovery. Severe symptoms or a high post-void residual push us to other options.

  • Combined boost with EBRT for higher risk

    Occasionally used as a brachy boost after 45Gy of external beam in selected higher-risk disease, on an MDT basis.

  • Recent TURP within 6 months

    A large TURP defect changes seed geometry and raises the incontinence risk, so most centres defer or choose a different modality.

  • High-risk or locally advanced disease

    Gleason 4+4 and above, PSA over 20, or extracapsular extension are not for LDR monotherapy. We discuss HDR boost, EBRT plus ADT, or surgery.

  • Red flag: bone pain or lymphadenopathy

    New bone pain, weight loss or nodal disease on staging needs the MDT and systemic treatment plan, not a private brachy booking.

Treatment options

LDR is a family of techniques - and HDR sits beside it.

What each option on the table actually involves - and which fits which patient. For higher-risk disease we discuss HDR boost or SBRT alongside LDR at the MDT.

  • Iodine-125 permanent seeds

    The standard isotope in UK practice. Low-energy photons, a half-life of 60 days, and a dose delivered slowly over 6 to 9 months as the seeds decay.

  • Palladium-103 seeds

    A faster half-life of 17 days delivers more dose earlier, favoured by some centres for higher-grade disease. Fewer UK centres, so availability varies.

  • Intra-operative TRUS planning

    A live ultrasound plan is generated in theatre, needles and seeds placed to that plan in one sitting. The modern default in most UK centres.

  • Pre-plan with volume study

    A separate volume-study appointment plans the implant days ahead. Still used in some centres, particularly for training and audit.

  • Stranded versus loose seeds

    Loose seeds are placed individually with a Mick applicator; stranded seeds are pre-loaded on absorbable suture. Stranded seeds migrate less.

  • LDR monotherapy

    A single treatment delivering the entire radiotherapy dose. The usual approach for low-risk and favourable intermediate-risk disease.

  • LDR as a boost after EBRT

    Around 100Gy of LDR after 45Gy of external beam for selected intermediate and high-risk disease, on an MDT basis.

  • Second-opinion review

    A specialist review of your MDT letter, MRI and biopsy pathology to check LDR is the right modality for you.

Outcomes

Ten-year outcomes from large series and the ProtecT-era comparisons. In the right risk group, LDR matches surgery and external beam for cancer control, with a different side-effect profile.

  • Low-risk: 10-year biochemical control over 95%

    Long-term series in Gleason 3+3 disease show sustained PSA control comparable to or better than external beam and surgery.

  • Favourable intermediate-risk: 85-90%

    In selected 3+4 disease, LDR monotherapy achieves 85 to 90% biochemical control at 10 years. Combined LDR-boost regimens push this higher for less favourable cases.

  • Comparable to surgery and EBRT, different toxicity

    Head-to-head trials show similar cancer-specific survival at 10 years. LDR trades a lower risk of incontinence for higher rates of transient urinary irritation.

Side effects and recovery

What to expect afterwards - honestly.

LDR is well-established and generally well tolerated. The things worth planning are the urinary irritation months, the small retention risk, and the long-term impact on erections.

  • General anaesthetic for the implant

    A short general anaesthetic in a fully staffed theatre, with a consultant anaesthetist. Most patients are home within 4 to 6 hours.

  • Transient urinary irritation

    Urgency, frequency and a slower stream are common for 3 to 6 months. An alpha-blocker such as tamsulosin is started around the time of the implant.

  • Urinary retention in around 5%

    A few men need a short-term catheter after the implant. Most are catheter-free within days to a few weeks, and a small number need a formal bladder-neck procedure later.

  • Incontinence risk is low, under 5%

    Long-term stress incontinence is uncommon after LDR monotherapy. It is higher if a TURP is done later, which is why timing matters.

  • Erectile function at 3 to 5 years

    30 to 40% of men see a decline in erections by 3 to 5 years, less than after surgery. PDE5 inhibitors help in most cases.

  • Rectal side effects are uncommon

    Rectal urgency or minor bleeding affects a small minority. Serious fistula is rare, well under 1% in modern series.

  • Seed migration is usually silent

    A small proportion of seeds can migrate to the lungs or elsewhere. It is picked up on the post-implant CT and almost always without symptoms.

  • Urethral stricture in a minority

    Around 5 to 10% develop a bulbomembranous stricture over years, managed with dilatation or a short optical procedure.

  • Red flags after discharge

    Inability to pass urine, heavy bleeding, fever, or severe perineal pain need the on-call team the same day.

Radiation precautions

The practical rules for the first few months.

The seeds emit low-energy radiation, most of it absorbed inside the prostate. UK guidance sets simple, time-limited rules around family life and travel.

  • Pregnant women and infants for 2 months

    Limit prolonged close contact, and avoid holding babies or small children on your lap for long periods for around 2 months after the implant. Normal contact is fine.

  • Condoms for the first few ejaculations

    A very small chance of passing a seed in semen for the first two or three occasions after treatment. A condom removes the risk.

  • Airport security after 3-6 months

    Modern airport scanners rarely pick the seeds up after around 3 to 6 months. You will be given a wallet card to carry that explains the implant if needed.

Compared to

LDR next to HDR, SBRT, surgery and proton.

Every localised prostate cancer decision is a trade-off between control, side effects and lifestyle. Here is how LDR sits alongside the main alternatives.

  • LDR (this treatment)

    One day-case implant, permanent seeds, no follow-up radiotherapy visits. Dose released slowly over months from within the prostate.

  • HDR brachytherapy

    One or two visits under GA with a temporary high-activity source. No permanent seeds. Increasingly used as a boost for higher-risk disease.

  • SBRT (5-fraction)

    Five non-invasive external beam sessions on an MR-linac or CyberKnife over 1 to 2 weeks. No needles, no anaesthetic, wider dose to normal tissue.

  • Robotic prostatectomy

    Definitive surgical removal in one operation, with the trade-off of incontinence and erectile dysfunction rates that are higher than LDR.

  • Proton beam therapy

    External beam using protons. Dose-distribution debate continues; UK availability is limited and evidence versus modern IMRT and SBRT is mixed.

  • Active surveillance

    For very low-risk disease, delaying treatment with a structured programme of PSA, MRI and biopsy remains a valid, evidence-based choice.

Reading your brachytherapy report

Your implant report in four parts. Read the last one first.

Whichever centre you go to, the report the oncologist sends you keeps to the same shape.

A UK clinical oncologist reviewing a brachytherapy dosimetry report

A quiet reminder

Dosimetry 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

    Isotope, seed count and target volume

    Which isotope was used (iodine-125 or palladium-103), how many seeds were implanted, and the prescribed dose to the prostate.

  2. 02 Technique

    Needles, template and imaging guidance

    The number of needles, the template co-ordinates used, and whether TRUS with fluoroscopy or intra-operative planning guided the implant.

  3. 03 Findings

    Dosimetry: V100, D90 and urethral dose

    The percentage of prostate covered by the prescription dose (V100), the dose to 90% of the gland (D90), and the dose to the urethra and rectum.

  4. 04 Impression

    Follow-up plan and PSA schedule

    Read this first: when your post-implant CT is booked, your alpha-blocker plan, and the PSA follow-up interval for the first two years.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for LDR seed brachytherapy is standard across major UK insurers for eligible localised prostate cancer.

Frequently asked

Everything we get asked about LDR seed brachytherapy.

Quick answers on radiation to your family, insurance cover, sexual function, MDT review and seed migration.

  • Am I radioactive to my family after LDR seed brachytherapy?

    You emit low levels of radiation for the first few months, most of it absorbed inside the prostate. UK guidance is to limit prolonged close contact with pregnant women and infants for around 2 months, and to avoid holding small children on your lap for extended periods. Normal contact, work and travel are fine. The seeds are not detectable at airport security after roughly 3 to 6 months, and you will be given a wallet card in case they are.

  • Is LDR seed brachytherapy covered by private insurance?

    Most major UK insurers, including Bupa, AXA Health, Vitality, Aviva, WPA and Cigna, cover LDR seed brachytherapy for eligible localised prostate cancer. Cover is confirmed once we have your MDT letter and staging.

  • How does LDR affect sexual function and fertility?

    Roughly 30 to 40% of men see a decline in erections by 3 to 5 years after LDR, less than after robotic prostatectomy. PDE5 inhibitors such as sildenafil or tadalafil help most men. Ejaculatory volume typically reduces or stops, and fertility should not be assumed. If future biological children are important, sperm banking before treatment is offered.

  • Can LDR seed brachytherapy be repeated if the cancer comes back?

    Repeat LDR is uncommon and only offered in very selected cases in specialist centres. If PSA rises after LDR, the more usual salvage options are focal therapy for a small local recurrence, salvage prostatectomy, salvage cryotherapy or systemic treatment, chosen at the MDT.

  • Is my case reviewed by a multidisciplinary team?

    Yes. The letter is shared with you and with your GP, so the plan is not one clinicians opinion.

  • What happens if a seed migrates out of the prostate?

    A small percentage of seeds can migrate through veins to the lungs or, rarely, elsewhere. This is picked up on the routine post-implant CT and is almost always symptom-free and clinically insignificant. Stranded seeds, pre-loaded on absorbable suture, have made migration far less common than it used to be.

Related treatments

Looking at other options?