Brachytherapy for prostate cancer: summary of American Brachytherapy Society recommendations

This article summarizes recent American Brachytherapy Society (ABS) recommendations for permanent prostate brachytherapy. The ABS recommends treating patients with high probability of organ-confined disease with brachytherapy alone. Brachytherapy candidates with a significant risk of extraprostatic extension should be treated with supplemental external beam radiation therapy (EBRT). The recommended prescription doses for monotherapy are 145 Gy for (125)I and 125 Gy for (103)Pd. The corresponding boost doses (after 40 to 50 Gy EBRT) are 110 Gy and 100 Gy, respectively. The ABS recommends that post-implant dosimetry should be performed on all patients undergoing permanent prostate brachytherapy for optimal patient care. A dose-volume histogram (DVH) of the prostate should be performed and the D(90) (dose to 90% of the prostate gland) reported by all centers. Additionally, the D(80) D(100), the fractional V(80), V(90), V(100), V(150), V(200) (ie, the percentage of prostate volume receiving 80%, 90%, 100%, 150%, and 200% of the prescribed dose, respectively), the rectal and urethral doses should be reported and ultimately correlated with clinical outcome in the research environment. On-line, real-time dosimetry, the effects of dose heterogeneity, and the effects of tissue heterogeneity need further investigation.