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Prostate High Dose Radiation (HDR) Brachytherapy:

Patient Information

 

What is brachytherapy?

High Dose Radiation (HDR) Therapy is a form of brachytherapy. Brachytherapy is a type of radiation therapy where a radioactive material is placed directly into or next to a tumor. It will be placed in your prostate by your Radiation Oncologist while you are under anesthesia. 

How should I prepare for my HDR treatment?

  • You must have pre-procedure testing with your primary care provider or cardiologist (heart doctor) before your procedure. This testing should include: an electrocardiogram (EKG) done within 6 months before your HDR. You will also need blood tests including a comprehensive metabolic panel and complete blood count done no more than 30 days before your HDR. You may need other tests based on your medical history.

  • 7 days before your procedure, you should stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements. These can raise your risk for bleeding.

    • If your doctor advises you to stop any prescribed blood thinner medications, please do so under their guidance.

    • Common blood thinning medications are:

      • Aspirin

      • Heparin

      • Warfarin (Coumadin)

      • Clopidogrel (Plavix)

      • Enoxaparin (Lovenox)

      • Dabigatran (Pradaxa)

      • Apixaban (Eliquis)

      • Rivaroxaban (Xarelto)

      • Ticagrelor (Brilinta)

    • 2 days before your procedure, you should stop taking nonsteroidal anti-inflammatory drugs (NSAIDS) such as Ibuprofen (Advil/Motrin) and Naproxen (Aleve) because these can cause bleeding. Do not drink alcohol because it can also raise your risk for bleeding.

    • 1 day before your procedure, you will do a bowel prep.

      • Start a clear liquid diet at 1 pm the day before your HDR. You can only have clear liquids. Clear liquids are those that you can see through (water, juices without pulp, broth, Jell-O, flavored ices, clear nutritional drinks [Ensure Clear], sodas such as ginger ale or Sprite, sports drinks such as Gatorade, black coffee or tea).

      • At 1 pm the day before your procedure, take one 5 mg Bisacodyl (Dulcolax) tablet. This medication is sold over-the-counter at your local pharmacy.

      • At 3 pm the day before your procedure, start drinking your NuLytely mixture. (This is a laxative prescribed by your doctor.) You will start having liquid bowel movements. This usually happens within 1-2 hours of taking this medication. You only need to drink ½ of this mixture, or 64 ounces.Please finish drinking your 64 ounces of Nulytely by 5 pm.

        • You will drink your NuLytely by having eight 8-ounce glasses of it between 3 pm and 5 pm.  (This is about one glass every 15 minutes for a total of 64 ounces.)

    • Do not eat or drink anything after midnight. (Small sips of water are okay with medications the next morning, if your doctor has told you to take them).

    • Shower the night before the procedure. Do not apply anything to your skin after the shower. This includes lotion, powder, etc.

    • DO NOT TAKE oral diabetic medications on the day of the procedure. This is because you will not be eating. However, please bring them to your procedure.

    • Please inform your radiation oncology and primary care team if you take any of the following medications for diabetes or weight loss: Ozempic, Mounjaro, Wegovy, Trulicity, Rybelsus, Saxenda, Zepbound or any similar medications. These medications delay gastric emptying. You must not take them on the day of your procedure. This is so you can safely receive anesthesia.

What should I expect the day of my procedure?

  • Do not eat or drink anything on the morning of your procedure. If your primary care doctor or cardiologist has told you take any specific medications that morning, please do so with a small sip of water.

  • Please arrive on time at the Radiation Oncology Department in the Energy Building at NYU Langone. Second floor, blue pathway.

  • Do not wear any jewelry or other metal objects.

  • Do not wear contact lenses. Wear your glasses instead.

  • A nurse will meet with you before the procedure. Please tell them of any medication changes. Please also let them know if you have dentures or hearing aids with you.

  • The nurse will check your vital signs, have you change into a hospital gown, and place an intravenous (IV) line for the procedure.

What should I expect during my HDR treatment?

  • A nurse will bring you to the procedure room. You will receive anesthesia for the procedure.

  • After you are asleep, a urinary catheter will be placed to drain your bladder of urine.

  • The radiation will be delivered through tubes which are connected to needles. To do this, your Radiation Oncologist will first use ultrasound to place the needles in the perineum (the area of skin between your anus and scrotum, or anus and vagina). Your Radiation Oncologist and the medical physicists will then develop your treatment plan. This is also known as mapping and it may take anywhere from 1 to 1.5 hours. Once completed, the tubes are connected to the needles and your radiation treatment will be delivered. This takes about 5-10 minutes.

  • Once the radiation is delivered, the tubes are disconnected, the needles removed and a Care Team member will apply pressure to your perineum to help stop any bleeding.

  • You may also have fiducial markers and / or a rectal spacer gel placed during your HDR procedure. This would be to prepare you for external radiation, if needed. (If your treatment plan includes external radiation, it would start in 2 weeks.)

    • Fiducial Markers are tiny metal objects (about the size of a grain of rice) which help guide external radiation. These remain in the prostate after your treatment.

    • Rectal Spacer is gel that is injected between your rectum and prostate. it protects your rectum from the radiation delivered to your prostate. This gel remains in place for about 3 months. It will be absorbed by your body over time and removed in your urine.

    • You will not be radioactive and you do not need to follow any radiation precautions.

    • The urinary catheter will be removed before you wake up.


What should I expect after my HDR treatment?

  • The nurse will check your vital signs and pain in the recovery room. We will give you pain medication if you need it.

  • We will give you one dose of Tamsulosin (Flomax) after your procedure to help with urination.

  • You will receive one dose of Pyridium after the procedure to help with any burning. This will turn your urine orange.

  • In rare cases, a urinary catheter may be reinserted if you are not able to urinate on your own.

  • A nurse will review discharge instructions with you.

  • Once you are feeling well and are able to urinate on your own, you can go home.

  • Please arrange for a chaperone (a responsible person age 18 or older) to take you home safely.

What should I expect at home after my HDR Treatment?

  • You can resume your normal diet.

  • You can drive and resume normal activities 24 hours after your procedure.

  • You can shower as soon as you arrive home from the procedure.

  • There may be a small amount of blood in your urine. This should go away on its own after 2-3 days. Please drink plenty of water to avoid clotting.

  • There can be some urinary burning after your procedure. This should get better in 2-3 days. Your doctor will send you home with more Pyridium to help with this symptom.

  • We will give you will a prescription for antibiotics. You need to take them for 3 days.

  • Most patients have bruising and soreness in the perineum. This should get better within 1 week.

  • Avoid sexual activity for 1 week after the procedure. You may notice a small amount blood in the ejaculate. This is normal and should get better on its own. Call your doctor if you have pain with orgasm. Avoid receptive anal intercourse or instrumentation in the rectum for at least 3 months.

 

When should I call my doctor?

  • If you are not able to urinate when you get home.

  • If you have blood in your urine or stool that does not get better on its own.

  • If you notice swelling around your scrotum, testicles, and penis.

  • If you develop a fever of 100.4◦F (38◦C) or higher, or chills.

  • If you have new or increased pain that is not managed with over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil).


If you have any questions, please call the Radiation Oncology Department at:

  • Perlmutter Cancer Center: 212-731-5003

  • Energy Building: 646-501-8900

 

©2024 NYU Langone Health. All rights reserved. Reviewed for health literacy. This information is not intended as a substitute for professional medical care. Always follow your health care provider's instructions.