Salvage high-dose-rate brachytherapy (HDR-BT)
Topic Status Complete
Salvage high-dose-rate brachytherapy (HDR-BT) for localised relapse of prostate cancer after prior curative intent radiotherapy.
Outcome of the appraisal
More evidence is needed on salvage high-dose-rate brachytherapy for local or locally advanced relapse of prostate cancer after prior curative intent radiotherapy.
There was limited clinical effectiveness evidence for salvage high-dose-rate brachytherapy (HDR-BT) for local or locally advanced relapse of prostate cancer compared to salvage radical prostatectomy or salvage stereotactic ablative body radiotherapy (SABR).
HTW was unable to determine cost effectiveness because the effectiveness evidence was insufficient to use for a robust evaluation.
Salvage HDR-BT is currently accessed through the Individual Patient Funding Requests (IPFR) process. The Appraisal Panel was supportive of this route for access to treatment and said that patient reported outcome and survival outcome data should be collected from people who received salvage HDR-BT
Why was this topic appraised?
Radical prostatectomy, stereotactic ablative body therapy (SABR) or high-dose-rate brachytherapy (HDR-BT) can be used as salvage treatment for locally recurrent prostate cancer after primary, curative, radical radiotherapy. In Wales, standard of care for salvage treatment for locally recurrent prostate cancer is radical prostatectomy. Where people are unsuitable for surgery, long-term palliative systemic treatment is prescribed. It is proposed that salvage HDR-BT can be offered as an alternative to salvage radical prostatectomy in Wales.
This topic was proposed by a consultant clinical oncologist working in the NHS in Wales.
Plain language summary
What is Prostate Cancer?
Prostate cancer happens when cells in the prostate grow out of control and form a tumour. Prostate cancer can cause:
- difficulty passing urine,
- needing to go urgently or often,
- waking up at night to urinate
- feeling as if the bladder has not fully emptied.
One possible treatment is radiotherapy. After treatment, if cancer returns to the same area, this is called a “local relapse” or “local failure.”. When this happens, further treatment is needed.
What is salvage brachytherapy ?
Salvage high-dose-rate brachytherapy (HDR-BT) is a type of internal radiotherapy. Thin tubes are temporarily placed inside the prostate to help deliver radiation directly to the tumour. This targets the cancer cells while reducing damage to the surrounding healthy tissue.
In Wales, the main treatment when prostate cancer returns is radical prostatectomy. This is surgery to remove the whole prostate gland and some surrounding tissue. While effective, this surgery can cause side effects such as problems with erections (sexual function), urinary incontinence (leakage), and infections.
What did Health Technology Wales look at?
Health Technology Wales looked at the evidence that salvage high-dose-rate brachytherapy can be used for people with relapsed prostate cancer instead of prostatectomy. More evidence is needed before a recommendation can be made.
Guidance
GUI074 02.2026
Evidence Appraisal Report
EAR074 02.2026
Topic Exploration Report
TER596 05.2025 (superseded by EAR074 02.2026)
Health Technology Wales Partners
