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HDR (high dose rate) brachytherapy uses a single high intensity radioactive source on a long computer controlled cable to deliver radiation to tumors, rather than using permanently implanted radioactive seeds. Use of HDR in the prostate avoids the patient becoming radioactive, thus eliminating the need to be careful about exposure of children, women of child-bearing age, and spouses. Because the location and times of the radioactive source placements, the dose can be much more closely controlled than with seed implants. The dose is delivered in a few minutes, then the implant is removed. Andy Grove, former CEO of the Intel Corporation, once said that HDR was like smart bombing rather than the carpet bombing of seeds.
Prostate HDR brachytherapy is used in two ways: as a boost, and as primary treatment. When used as a boost, it is used in men with more aggressive cancer, and has been shown to have about a 98% local control rate, higher than any other method of treatment. In addition, it reduces acute side effects and long-term complications by about 50%, and reduces the risk of impotence by about two-thirds.
It can also be used in men with earlier and less aggressive cancers. Treatment is completed in two days, and results have been at least as good as with seed implants, and again with reduced side effects.
