Low dose rate (LDR) brachytherapy is an internal radiotherapy method used principally to treat localised prostate cancers. It consists of implanting small radioactive sources (generally iode-125) directly into the prostate. These “seeds” emit low dose radiation over a long period, making it possible to destroy the tumour while preserving the neighbouring tissue.
This is particularly suitable for men who want a treatment with minimum impact on their quality of life, notably in terms of urinary and sexual functions. LDR brachytherapy is suitable for patients with a localised prostate cancer of intermediate risk, presenting a good urinary function and
LDR brachytherapy is a single intervention with a short period of hospitalisation and rapid recovery.
Pre-treatment evaluation
The pre-treatment evaluation includes a questionnaire on urinary quality of life and a urine output and residual urine evaluation. A transrectal ultrasound is also carried out to measure the prostate volume.
Intervention
The intervention is carried out under a general or locoregional anaesthetic and consists of implanting radioactive seeds directly into the prostate using needles guided by transrectal ultrasound. The procedure generally lasts between 1 and 2 hours and is completed in a single session.
Hospitalisation
The patient is hospitalised for 24 hours with one overnight stay.
Follow-up
Normal activities can be resumed after a few days while respecting the temporary measures as instructed to limit the radiation exposure of others.
Regular monitoring is needed, including PSA tests to assess the treatment effectiveness. Imaging (MRI, PSMA PET) examinations can be carried out if necessary.
LDR brachytherapy has a number of advantages compared to conventional treatment:
- Targeted treatment: Limits damage to healthy tissue.
- Preservation of functions: Reduces risk of urinary incontinence and erectile dysfunction.
- Comfort: Single procedure and rapid recovery.
- Proven effectiveness: Comparable to surgery for localised cancers.
LDR brachytherapy is generally well tolerated but like any treatment there can be side effects. Temporary urinary problems are the most frequent with a frequent desire to urinate, a feeling of urgency to urinate or sometimes difficulty in urinating or even temporary retention. Slight rectal irritation can also occur although it is rare.
In the long term some patients may experience erectile function problems, especially if the tumour is close to the erectile nerves, with a risk estimated at between 20% and 30%. Although rare, the displacement or migration of the radioactive seeds can result in minor complications requiring specific care.
An old method in the service of modernity
First appearing at the start of the 20th century, brachytherapy is one of the oldest forms of radiotherapy and was initially developed after Marie Currie discovered radium. The concept was explored from 1901 by Pierre Curie and Dr Henri-Alexandre Danlos to treat skin cancers. The French term for brachytherapy is “curiethérapie”, in homage to Curie whose work made it possible to establish this therapeutic approach.
First used to treat various forms of cancer, brachytherapy has developed thanks to technological progress and is today a high technology suitable for treating prostate cancer.
LDR brachytherapy reflects this evolution. Although it is based on the same fundamental principle — placing radioactive sources directly in the tumour to maximise effectiveness while sparing healthy tissue — it now benefits from imaging and precise guiding tools, such as MRI and ultrasound. .
This combination of historical know-how and modern technology makes brachytherapy a pertinent treatment option, effective and respecting the quality of life of patients.