Contemporary trends in prostate brachytherapy

Prostate brachytherapy enables delivery of an ablative dose of radiation to the cancer with advantage of rapid fall-off in dose and sparing of neighbouring organs. Modern external beam radiotherapy using inverse planning, intensity modulation and image guidance enables to moderate dose escalation, but with much higher integral dose. Mature data show, that brachytherapy results in consistently high local control rates, high disease-free survival and low risk of long-term morbidity. Ultrasound-guided permanent implantation (vLDR brachytherapy) is mature procedure many years. With use of information from new diagnostic methods during brachytherapy planning we are able to escalate radiation dose within the prostate gland (voxels suspicious from malignancy) respecting normal tissue dose constrains. Establishment of HDR brachytherapy in the field of prostate cancer is logical thanks to technological development. Use of HDR brachytherapy is supported by the guidelines only as a boost after external beam radiotherapy in intermediate and high risk prostate cancer or as salvage therapy. Even no particular dose fractionation schedule could be recommended by guidelines, all data are reporting favourable outcomes despite of the heterogeneity in dose prescription in the literature. (author)