Current controversies in prostate brachytherapy for prostate cancer

Prostate cancer remains the most commonly diagnosed malignancy in men. An estimated 161,360 new cases will be diagnosed in 2017 in the United States, accounting for 19% of male cancer diagnoses and 8% of cancer mortality in men.1 Localized prostate cancer management represents a challenge for clinicians as several definitive treatment options exist including surgical resection, external-beam radiation therapy (EBRT) +/brachytherapy boost, high dose rate brachytherapy (HDR-BT), and low dose rate brachytherapy (LDR-BT). Treatment recommendations and decisions are often based on patient age, comorbidities, risk stratification, as well as patient preference. LDR-BT is an attractive option for many patients, either as monotherapy or in combination with EBRT. Brachytherapy techniques have continued to evolve over the past several decades with new data supporting technical innovation and revised treatment indications. The purpose of this review is to summarize the role of LDR-BT in managing prostate cancer and to discuss patient selection in a contemporary context.