How to you sequence HDR brachytherapy for definitive prostate cancer treatment?

This is a great question, for which there are several options. I think a lot of it comes down to your department capabilities, trade-offs, what you and your team are comfortable with, etc.

When starting the prostate HDR brachytherapy program at MGH, I spoke to many different centers that had it up ...

For our prostate cancer patients (favorable risk, favorable intermediate risk, and biopsy proven local recurrences) who are treated with 2 HDR fractions (13.5 Gy x 2 or 12 Gy x 2), our typical sequence is two implants separated by 1 week. We sometimes separate the implants by 2 weeks, but this is be...

We have been doing HDR monotherapy since 2000. We started out with 700x6 fraction with two implants 2 weeks apart, then 950x4 fractions with 2 implants 2 weeks apart. We now do 1350x2 with 2 implants either 1 or 2 weeks apart for the last 8 years. The patient does very well. We seem to see a little ...

I've mostly done HDR monotherapy 27 Gy divided in 2 fractions q 2 weeks as well, based on Beaumont's original design, but likewise, have seen no qualitative differences in outcomes, quality of life in those I've done at one week intervals for a variety of reasons.

Once you get really really good at...