In providing a comprehensive cancer service, Epworth Radiation Oncology through its dedicated team of radiation oncologists, physicists, radiation therapists and nurses will offer patients highly specialised treatments with its brachytherapy program.


Epworth Radiation Oncology offers a full suite of Brachytherapy services with High Dose Rate Brachytherapy for gynaecological malignancies at Epworth Freemasons, Headed by Dr Bronwyn King.  Epworth Radiation Oncology also offers Low Dose Rate Brachytherapy for prostate cancer at Richmond, Freemasons and Eastern sites Headed by Dr Andrew See.


What is brachytherapy?


Brachytherapy is a special form of radiation therapy where a radioactive source is placed beside or inside the tumour.  The term brachytherapy was derived from the Greek word “brachy” meaning “short-distance”.  Brachytherapy is commonly used, but not limited to, the effective treatment of gynaecological, prostate, breast and skin cancers.


Brachytherapy is administered through either a permanent radioactive seed implant (Low Dose Rate “LDR” treatment) or through moving a radioactive source in and/or around the cancer (High Dose Rate “HDR” treatment).  With HDR treatment, the radioactive source is retracted out of body once depositing the prescribed dose by the radiation oncologist.  Our Radiation Oncologists will discuss which treatment is suitable for you.


The benefits of brachytherapy compared with other forms of radiation treatment include:

  • Ability to deliver high localised dose

  • Rapid fall off of dose

  • Ability to sculpt dose to shape of tumour or organ of interest


Brachytherapy for prostate cancer


The cause of prostate cancer is unknown, and with its incidence increasing with age, early detection is leading to potentially curable treatment. While many are referred for radical prostatectomy or external beam radiation using conformal techniques there are a number who are suitable for brachytherapy which has the potential advantages of convenience, relatively low morbidity and effectiveness.


LDR brachytherapy is a very targeted treatment using low energy radiation emmitted by Iodine-125. The seeds are no larger than an uncooked grain of rice, and are strategically injected to treat the prostate and minimise dose to surrounding structures.  The seeds remain radioactive between three to four months.


Seed brachytherapy offers comparable cure results  to both radical prostatectomy (including robotic surgery) and external beam radiation treatment. The choice between which treatment option is most suitable for you will depend on the management of side effects in consultation with your oncologist.


Planning for prostate cancer brachytherapy


A volume study is performed about one month before your implant to obtain data required for the brachytherapy team to plan your individualised conformal treatment. This involves indentifying the prostate using trans-rectal ultrasound (TRUS), and acquiring multiple detailed images through the prostate, whilst identifying critical structures such the urethra, rectum and bladder.  The procedure can be performed under anaesthetic or through preparing you oral medication. The procedure will take about one hour, generally allowing you to go home on the same day. 


Patient preparation for prostate cancer brachytherapy


  • Begin a low residue diet three days prior to your implant (please contact the Brachytherapy Co-ordinator or by phone on 03 9483 3895 for more information)

  • Change to a clear liquid diet around lunch time the day before your implant

  • Do not have anything to eat or drink from midnight the night before your implant

  • Administer a Microlax enema between 8.00pm and bedtime the night prior to your implant

  • Administer a second Microlax enema upon waking on the morning of your implant

  • Microlax enemas can be purchased from your local pharmacy without the need for a prescription


Prostate cancer brachytherapy treatment procedure


Your implant will typically take about one hour.  You will be under local anaesthetic with sedation or under general anaesthetic. Using TRUS, the oncologist will image through your prostate to replicate the images taken at your volume study.  This allows the oncologist and urologist to accurately inject the seeds through the perineum into the prostate as your plan dictates.  On average patients are injected with between 80-100 seeds using 20-30 needles. 


Depending on your recovery, patients will generally stay overnight with catheter in place to manage urine flow and flush the bladder.  Patients should avoid lifting or strenuous activity for three to five days.


Benefits and side effects of brachytherapy for prostate cancer



  • Cure rates equivalent to surgery and external beam radiation

  • Minimally invasive procedure completed within an hour, requiring minimal hospital stay

  • Incontinence is extremely rare

  • Impotence rates are the vicinity of 20 to 30%



  • Between one and six months following implantation it is common to experience the need to pass urine more frequently and your urinary flow may reduce. This occurs because there is a lot of swelling of prostate. In some men (less than 5%) it may be necessary to insert a temporary catheter into the bladder. Sometimes you will be recommended to take certain prescribed medications for the first few months after the implant to minimise flow problems

  • Although there are no regulatory requirements to isolate you after implantation, we do advise that for two months after the implantation you minimise contact with children under the age of three and pregnant women

  • Any prostate surgery following seed brachytherapy can be associated with increased risk


The side effects resulting from seed brachytherapy are less severe when compared surgery or external beam radiation. Treatment related side effects begin from one to two weeks after implant include urinary functions, change in bowel habits and sexual dysfunction.


Urinary side effects

Blood in your urine, increased frequency, burning, dribbling and blockage can occur after seed implant.  This is due to inflammation in the urethra, swelling of the prostate and irritation of the bladder from the radiation treatment.


Sexual function

One major concern amongst men in choosing treatment for prostate cancer is sexual function.  Unfortunately decreased potency and firmness is associated with curative treatment, however this is more common after surgery than after seed brachytherapy.


Bowel habits

Less likely, but not uncommon some men may have diarrhoea or loose bowel motions.  This can be managed by consuming a bland, low residue diets.


Please note that side effects do vary between individuals and usually last for three to six months after implantation.  Please contact the Brachytherapy Co-ordinator or by phone on 03 9483 3895 for further information on management of side effects.


Safety and what happens after your implant

The biggest concern for patients and their families is radiation safety after the implant.  Most of the radiation is absorbed by your body, and you would not be discharged unless these were at safe levels. Nevertheless, before leaving hospital, you will be given a medical alert card.  In the event of a medical emergency requiring hospitalisation (i.e. a car accident), this card will alert medical officers of your seed implantation.


Picking up a child or hugging a pregnant woman is fine. However, you should avoid prolonged contact for the first two months. For instance:

  • Avoid sitting a child on your lap.  Sitting beside you is fine

  • Keep about six feet from pregnant women (or potentially pregnant women)

  • Use a condom during intercourse.  Your body fluids are not radioactive and what you touch is not radioactive.  The use of a condom is recommended for the very low risk of a seed being passed and it is not uncommon for traces of blood to be found in your discharge.


Four weeks after your implant, you will be required to have CT scan.  This will allow the brachytherapy team to identify all the seeds implanted to calculate the dose given your prostate.  The timing of this scan is to allow for reduction in swelling of the prostate resulting from your implant.


Gynaecological brachytherapy for the vagina


Brachytherapy is an effective treatment used to treat the top of the vagina to reduce the risk of cancer recurring.


At your first treatment the radiation oncologist will perform a vaginal examination to determine the size of applicators to use for your treatment.  The applicators used at Epworth Radiation Oncology are ovoids (much like marshmallows on a stick) or a cylinder.  The radiation onoclogist will determine which is most suitable for you.  The radiation oncologist will then insert the applicators. You may feel a little discomfort, but this should not cause you pain. 


The catheters are then connected to the treatment machine, where the radiation source can pass into the applicators.  Your treatment will be given over four sessions, each session lasting about twenty minutes.


You will not require any special preparation for this treatment, and are free to go home after each treatment.


Frequently asked questions regarding vaginal brachytherapy


Side effects 

There are very little side effects associated with vaginal brachytherapy.  This treatment will only deliver a high radiation dose to several millimetres of tissue. 


There may be a change to your bowel habits, but this is very minimal.


Vaginal Stenosis (reduction in length of the vagina) has been seen in over 50% of women.  The use of a vaginal cylinder will help reduce this incidence.


Will I be radioactive?

You will not be radioactive.  The radiation source will pass into the applicators and retract back into the machine once the treatment has been delivered. You will not feel, see or hear the radiation. The brachytherapy team will then scan the room to ensure the source has travelled back into the machine.  The doctor and nurse will then remove the applicators.


What happens after my brachytherapy treatment?

Before leaving, our nurses will instruct you on the use of the vaginal cylinder and provide you with Ovestin cream.  An appointment will be made to see your radiation oncologist in four to six weeks time.