Acute and late side-effects after low dose-rate brachytherapy for prostate cancer; incidence, management and technical considerations

PURPOSE: To review common reported side effects and complications after primary LDR-BT (monotherapy) and discuss some of the technical aspects that could impact the treatment outcomes. METHODS AND MATERIALS: A literature search was undertaken using medical subject headings (MeSH) complemented by the authors' personal and institutional expertise. RESULTS: The reported incidence of acute and late grade 2 or above urinary, bowel and sexual side effects is very variable across the literature. The learning curve and the implant quality have a clear impact on the toxicity outcomes. Being aware of some of the technical challenges encountered during the procedure and ways to mitigate them could decrease the incidence of side effects. Careful planning of seed placement and seed deposition allow sparing of the organs at risk and a lower incidence of urinary and gastro-intestinal toxicity. CONCLUSIONS: Low dose-rate brachytherapy remains a standard monotherapy treatment in the setting of favorable-risk prostate cancer. High disease control and low long-term toxicities are achievable in expert hands with a good technique. (c) 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.