HDR Prostate Brachytherapy.

Brachytherapy has become an essential pillar in all-stages of localized prostate cancer, where dose escalation has been demonstrated to improve outcome. HDR brachytherapy has evolved over the decades to be administered in 1-2 fractions. As either monotherapy or in combination with external beam, it offers many advantages over other treatment alternatives. Precise control over dose delivery allows focal dose escalation while sculpting dose around critical organs to maintain excellent tolerance. The high dose per fraction exploits the low α/β ratio of prostate cancer and triggers transcriptional changes in the tumor genome enhancing radiation sensitivity. We review the development, patient selection and results, and describe in detail the techniques for HDR brachytherapy.