Progress in Low Dose Rate Brachytherapy for Prostate Cancer

Low dose rate (LDR) brachytherapy has a proven critical role in achieving the modern standard of successful prostate cancer treatment, cure with quality of life (QoL) preservation. In the past decade, cure has been demonstrated in the most lethal form of prostate cancer treated with combined external beam and LDR brachytherapy. Additionally, QoL has moved from toxicity avoidance to preservation of function, with unprecedented sexual function preservation proven with intensive combination therapy. The technical advances that have made such outcomes possible have defined the full, dynamic complexity of the permanent prostate implant procedure, as well as effective solutions. Progress in LDR brachytherapy as it relates to prostate cancer biology, local control, toxicity reduction with function preservation, external beam integration, medical event prevention, patient selection, and comparative brachytherapy is reviewed. As in all brachytherapy procedures, the final clinical outcomes of cure, and QoL depend entirely on a foundation of verifiable technical excellence. (C) 2019 The Authors. Published by Elsevier Inc.