Introduction Carcinoma of the prostate is the most common male malignancy in the United States, constituting 31% of newly diagnosed cancers, excluding basal and squamous cell cancers of the skin 1. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute estimates approximately 189,000 new cases of prostate cancer in 2002 in the USA1. Although prostate cancer screening remains controversial, widespread testing with the prostate specific antigen (PSA) blood test is largely responsible for the rise in incidence of prostate cancer between 1987 and 1995 2. This trend appears to have peaked in 1993 with the incidence of newly diagnosed cases falling by about 28% over the following 3 years 3. Although a steady decrease in prostate cancer mortality has been observed between 1994-1999 in the US, whether or not this stage ‘shift’ will result in lower prostate cancer morality remains to be proven. Currently, the American Cancer Society recommends an annual digital rectal exam and PSA test for all men over the age of 50. 1. When prostate cancer is clinically confined to the prostate, various treatment options are available, including radical prostatectomy, modified radical prostatectomy, external beam radiation therapy, brachytherapy, cryotherapy, hormonal therapy, and careful observation. Choosing a treatment is complex and may be influenced by various co-morbidities, disease-related factors and personal preferences. Specific management guidelines have been fraught with controversy. Despite much controversy, significant technical and procedural advances have established permanent prostate brachytherapy as a popular treatment option 4. Long-term data demonstrate results on par with other treatment modalities, in particular with radical prostatectomy and external beam radiation therapy 5. Thus, the decision process for most men remains daunting and is complicated by the lack of consistent publicly available information. While prostate cancer has been treated with brachytherapy since the early 1900’s with varying degrees of success, it was not until the 1970’s to the early 1980’s that brachytherapy made serious inroads in the treatment of prostate cancer with the introduction of the retropubic approach to prostate brachytherapy. Nonetheless, the results of the retropubic approach were not as favorable as desired and prostate brachytherapy fell out of favor 6. Based on our current understanding of the natural history of prostate cancer, the retropubic era was destined for failure. However, several important radiation oncology principles developed during that time continue to be applicable to modern brachytherapy techniques, including patient selection and dose response. We began to appreciate the importance of dosimetry in brachytherapy to help predict outcomes. This includes the concept of radiation dose response coupled to the concept of local control as a predictor for disease control 7. Modern transperineal brachytherapy techniques using ultrasound guidance with either iodine-125 or palladium-103 offer good alternatives for management of localized prostate cancer in appropriately selected patients. This modality allows delivery of a higher localized radiation dose than that achievable by external beam radiation alone; and it is an effective alternative to surgery for those patients who, for various reasons either may be unable to undergo surgery or who elect brachytherapy as an alternative therapy. The non-surgical, outpatient basis of permanent, ultrasound-guided transperineal prostate brachytherapy has high patient appeal and offers minimal morbidity in appropriately selected patients. Brachytherapy is convenient and cost effective, and it generally results in minimal impairment of the patient's lifestyle. However, it requires a motivated patient; one who understands the disturbing symptoms that can potentially occur 8. The accurate performance of today's implants has been aided by technological improvements, but quality implants still require skill, adequate training and extreme attention to detail. Although the final place of prostate brachytherapy in the armamentarium of prostate cancer treatment will await the maturation of long-term, controlled clinical trials, the future appears bright. Up | Brachytherapy Page 1 | Brachytherapy Page 2 | Brachytherapy Page 3 | Brachytherapy Page 4 | Brachytherapy Page 5 | Brachytherapy Page 6 | Brachytherapy Page 7 | Brachytherapy Page 8 |