Modern prostate brachytherapy

Of all the treatment options available for men with organ‐confined prostate cancer, brachytherapy—permament implantation of radioactive seeds into the prostate gland—is the least disruptive for the patient, both physiologically and practically. Early brachytherapy represents the oldest technique for delivering radiation to the prostate gland, preceding external beam therapy of the prostate by several decades. Although there have not been, and are not likely to be, any definitive randomized studies comparing radical prostatectomy, external beam radiotherapy, and brachytherapy, treatment decisions will continue to be made on the basis of patient and physician preferences in conjunction with clinical probabilities. Long‐term results in this series show that monotherapy with seed implants achieved disease‐free survival of 66%; moreover, 79% of patients with higher grade disease who were treated with a combination of brachytherapy and external beam radiation also experienced long‐term disease‐free survival. The following article provides a brief historical review of prostate brachytherapy, rationale for treatments, patient selection criteria, up‐to‐date implant techniques, and long‐term (12‐year) outcome results.