Introduction

Prostate brachytherapy represents the ultimate three-dimensional conformal therapy, permitting dose escalation far exceeding other radiation modalities with cancericidal treatment margins substantially larger than those obtainable with radical prostatectomy. Although the majority of the brachytherapy literature has demonstrated biochemical results and morbidity profiles that compare favorably with radical prostatectomy and external beam radiation therapy series, it has become increasingly apparent that efficacy and morbidity are highly dependent on implant quality. Sophisticated dosimetric analyses have demonstrated that cure rates, urinary and rectal complications and potency preservation are related to specific source placement patterns and the subsequent dose gradients produced. Our upcoming challenges include ensuring that high-quality brachytherapy is translatable from the subspecialist to the community practitioner, the development of intraoperative planning and dosimetry to maximize optimal dose distributions, improved intraoperative technique to include better delivery systems and imaging capabilities, and the development of evidence-based algorithms for patient selection and supplemental therapies including external beam radiation therapy and androgen deprivation therapy.