Permanent prostate brachytherapy: a century of technical evolution.

Area of Science:

• Urology
• Radiation Oncology
• Medical Physics

Background:

• Prostate brachytherapy, dating back to 1913, initially used radium capsules with limited success.
• Early implantation methods for prostate brachytherapy yielded unsatisfactory results.
• The development of transrectal ultrasound in the 1980s revolutionized prostate brachytherapy techniques.

Purpose of the Study:

• To summarize the practical development of interstitial permanent prostate brachytherapy (PPB) implantation techniques.
• To review the historical progression and evolution of PPB methods.
• To highlight key advancements in PPB over the last century.

Main Methods:

• Historical review of prostate brachytherapy techniques.
• Evolution from early radium capsule insertion to modern ultrasound-guided methods.
• Description of the two-stage Seattle technique and its impact on dose distribution.

Main Results:

• The Seattle technique enabled homogenous radioactive source distribution, achieving biochemical control comparable to surgery and external beam radiotherapy.
• Advanced computer software and imaging have led to single-stage procedures with on-table dosimetric assessment.
• Core principles of prostate dose targeting and organ-at-risk avoidance remain critical.

Conclusions:

• Permanent prostate brachytherapy has undergone significant technical evolution, driven by imaging and software advancements.
• Current techniques focus on precise dose delivery to the prostate while minimizing radiation to surrounding organs.
• The ultimate impact of evolving PPB techniques on long-term biochemical control requires further observation.