Core competencies in prostate HDR brachytherapy: An American Brachytherapy Society Endorsed Competency Framework

High‑dose‑rate (HDR) brachytherapy is an important treatment modality for prostate cancer, used as monotherapy for low‑ and favorable intermediate‑risk patients and as a boost for those with higher‑risk disease. It also remains a key option for patients with radio‑recurrent localized prostate cancer. HDR offers several advantages, including real-time image guidance for catheter placement, dynamic treatment plan optimization, precise dose customization, and lower radiation exposure for staff. As HDR brachytherapy becomes increasingly integrated into clinical practice, trainees are expected to acquire the knowledge and procedural proficiency necessary for independent practice by the completion of residency. Despite this expectation, few institutions offer formal brachytherapy training or fellowships, and there is limited guidance outlining the specific competencies required for HDR prostate brachytherapy. Existing documents, including guidelines from the American Brachytherapy Society (ABS) and GEC‑ESTRO, provide high‑level recommendations but are not HDR-specific competencies. The objective of this manuscript is to summarize current prostate HDR guidelines from ABS and GEC‑ESTRO and to establish a structured competency framework that training programs can adopt to ensure residents and fellows achieve proficiency in HDR prostate brachytherapy.