The second decade of prostate brachytherapy: evidence and cost based outcomes.

Permanent prostate brachytherapy (PPB) is an established and successful treatment option for localized prostate cancer. Under ultrasound guidance, the procedure can be performed in the ambulatory setting and represents a conformal, ablative technique. For low-risk patients, PSA control is expected in over 90% with outcomes now reported past 12 years. High-risk patients can benefit from PPB as part of a program that may include external beam therapy and androgen ablation. Morbidity tends to center on urinary function, but with modern adaptive techniques, this can be minimized. Sexual functioning is likely disturbed less with PPB than with surgery or external beam radiation therapy. Finally, cost benefit analysis confirms PPB as the most attractive radiation option. With the incidence of prostate cancer still rising, PPB remains a key treatment option in the successful management of prostate cancers.