The intermediate short-term results of brachytherapy (biochemical control levels and disease-free survival) for patients selected with a low risk of extraprostatic progression seem to be comparable to those of other therapeutic options, such as prostatectomy and external radiotherapy.
There are no long-term data available, despite the fact that the results of a sample (n=77) followed up for 12 years were recently published, with the same rate of disease-free survival as was observed after 10 years of follow-up (66%). Amongst the complications secondary to brachytherapy described are prostatitis and acute urethritis with greater frequency than after surgery, whereas impotence and urinary incontinence are also found in a smaller proportion.
Brachytherapy seems to be indicated for patients with a low risk of extracapsular extension (stagings T1, T2a; clearly differentiated and with low pretreatment rates of AST) with patients presenting prior irradiation of the pelvis, severe urethral obstruction and transurethral prostatic resection excluded.
There is uncertainty with regard to localised prostate cancer (PC). Despite the fact that there is evidence that this type of tumour tends to present a slow progression, it is not clear whether the type of treatment will or will not help all men with PC to live longer. On the other hand it must be remembered that treatments can affect patient quality of life. Thus, random-design clinical trials are needed with long follow-ups to confirm the efficacy and safety of brachytherapy, assess patient quality of life and define the role of this technique in the treatment of PC. In view of the lack of a therapeutical alternative that is clearly better than the rest, and of the existence of major side effects of some therapeutic options, it is becoming increasingly more necessary to consider the values and the preferences of patients in the approach to this clinical condition.