High-dose-rate Brachytherapy for Prostate Cancer

Introduction/Background Over the last 2 decades, significant technical advancements have improved the delivery of prostate brachytherapy. The transrectal ultrasound-guided implant technique is the backbone of modern prostate brachytherapy. Whether it is permanent or temporary, ie, low-dose-rate (LDR) or high-dose-rate (HDR), respectively, both use similar image-guided techniques for inserting seed-bearing needles or afterloading catheters. This image-guided implant technique has improved the quality and reproducibility of prostate brachytherapy. In HDR brachytherapy, a computer-programmed remote afterloader is used to insert the radioactive source into the patient. This has several important practical advantages: (1) it is a reusable radioactive source, (2) there is no radiation exposure for hospital personnel, and (3) it offers flexible dosimetry. Our understanding of the radiobiology of hypofractionation, however, has changed the clinical application of HDR brachytherapy.