Journal of Contemporary Brachytherapy
eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
Current Issue Archive Supplements Articles in Press Journal Information Aims and Scope Editorial Office Editorial Board Register as Author Register as Reviewer Instructions for Authors Abstracting and indexing Subscription Advertising Information Links
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
Search
Share:
Send email
Share:
Review paper

Polish Brachytherapy Society clinical recommendations and expert consensus on radical high-dose-rate brachytherapy for prostate cancer

Artur J. Chyrek
1, 2
,
Marcin Hetnał
3, 4
,
Andrzej Kukiełka
5
,
Piotr Lelek
6
,
Adam Kluska
1
,
Agata Romaniszyn
4
,
Natalia Samołyk-Kogaczewska
5
,
Wojciech Burchardt
1, 2
,
Paweł Cisek
7
,
Tomasz Krzysztofiak
6
,
Mirosław Kolbusz
8
,
Damian Kazalski
8
,
Tomasz Filipowski
9
,
Dorota Kazberuk
9
,
Anna Szmigiel-Trzcińska
9
,
Kacper Celarek
10
,
Piotr Madej
10
,
Katarzyna Konat-Bąska
11, 12
,
Krystian Lichoń
12
,
Robert Matys
13
,
Mateusz Bilski
5, 7
,
Ewa Burchardt
2, 14
,
Magdalena Stankiewicz
6
,
Adam Chicheł
1
,
Piotr Wojcieszek
6

  1. Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland
  2. Electroradiology Department, Poznan University of Medical Sciences, Poznań, Poland
  3. Faculty of Medicine & Health Sciences, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
  4. Radiotherapy Centre Amethyst, Rydygier Memorial Hospital, Kraków, Poland
  5. Department of Radiotherapy, Affidea NU-MED Cancer Diagnostics and Therapy Centre, Zamość, Poland
  6. Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
  7. Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
  8. Brachytherapy Department, Subcarpathian Cancer Center, Brzozów, Poland
  9. Radiotherapy Department, Bialystok Oncology Center, Białystok, Poland
  10. Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Kraków, Poland
  11. Department of Oncology, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
  12. Radiotherapy Department, Lower Silesian Oncology, Pulmonology and Hematology Center, Wrocław, Poland
  13. Radiotherapy Department, Affidea International Oncology Center, Koszalin, Poland
  14. Department of Radiotherapy and Gynecological Oncology, Greater Poland Cancer Centre, Poznan, Poland
J Contemp Brachytherapy 2026
DOI: https://doi.org/10.5114/jcb.2026.160423
Online publish date: 2026/03/30
Article file
- Polish Brachytherapy Society clinical recommendations.pdf  [0.35 MB]
Get citation
 
 
1. Krajowy Rejestr Nowotworów: http://onkologia.org.pl/
2. Ash D, Flynn A, Battermann J et al.; ESTRO/EAU Urological Brachytherapy Group; EORTC Radiotherapy Group. ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 2000; 57: 315-321.
3. Henry A, Pieters BR, André Siebert F, Hoskin P; UROGEC group of GEC ESTRO with endorsement by the European Association of Urology. GEC-ESTRO ACROP prostate brachytherapy guidelines. Radiother Oncol 2022; 167: 244-251.
4. Hoskin PJ, Colombo A, Henry A et al. GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: an update. Radiother Oncol 2013; 107: 325-332.
5. Wojcieszek P, Szlag M, Głowacki G et al. Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure. Radiother Oncol 2016; 119: 405-410.
6. NCCN Clinical Practice Guidelines in Oncology, Prostate Cancer, Version 2.2025, April 16, 2025.
7. Cornford P, van den Bergh RCN, Briers E et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2024; 86: 148-163.
8. Miszczyk M, Magrowski Ł, Krzysztofiak T et al. Brachytherapy boost improves survival and decreases risk of developing distant metastases compared to external beam radiotherapy alone in intermediate and high risk group prostate cancer patients. Radiother Oncol 2023; 183: 109632.
9. Skowronek J, Kanikowski M, Zwierzchowski G, Chicheł A. Brachyterapia LDR w leczeniu raka gruczołu krokowego. Współcz Onkol 2009; 6: 316-329.
10. Kukiełka AM, Hetnał M, Bereza K. Evaluation of tolerance and toxicity of high-dose-rate brachytherapy boost combined with interstitial hyperthermia for prostate cancer. Int J Hyperthermia 2016; 32: 324-330.
11. Burchardt W, Skowronek J, Łyczek J. Samodzielna brachyterapia HDR raka gruczołu krokowego – alternatywa we wczesnym stopniu zaawansowania. Przegląd Urologiczny 2012; 4.
12. Kluska A, Chyrek A, Burchardt WM et al. Ultra-low dose rate brachytherapy (uLDR-BT) in treatment of patients with unfavorable intermediate-risk group prostate cancer – retrospective analysis. Rep Pract Oncol Radiother 2024; 29: 600-605.
13. Kukiełka A, Dąbrowski T, Walasek T et al. High-dose-rate brachytherapy as a monotherapy for prostate cancer – Single-institution results of the extreme fractionation regimen. Brachytherapy 2015; 14: 359-365.
14. Yamada Y, Rogers L, Demanes DJ. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy 2012; 11: 20-32.
15. Atkins D, Best D, Briss PA et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490.
16. Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol 2021; 11: 116-129.
17. Boyle HJ, Alibhai S, Decoster L et al. Updated recommendations of the International Society of Geriatric Oncology on prostate cancer management in older patients. Eur J Cancer 2019; 116: 116-136.
18. Barry MJ, Fowler FJ Jr, O’Leary MP et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 1992; 148: 1549-1557.
19. Rosen RC, Riley A, Wagner G et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822-830.
20. Press RH, Morgan TM, Cutrell PK et al. Patient-reported health-related quality of life outcomes after HDR brachytherapy between small (<60 cc) and large (≥60 cc) prostate glands. Brachytherapy 2019; 18: 13-21.
21. Vigneault E, Mbodji K, Beaudet ME et al. Does prostate volume has an impact on biochemical failure in patients with localized prostate cancer treated with HDR boost? Radiother Oncol 2016; 121: 304-309.
22. Bellon J, Wallner K, Ellis W et al. Use of pelvic CT scanning to evaluate pubic arch interference of transperineal prostate brachytherapy. Int J Radiat Oncol Biol Phys 1999; 43: 579-581.
23. Wang H, Wallner K, Sutlief S et al. Transperineal brachytherapy in patients with large prostate glands. Int J Cancer 2000; 90: 199-205.
24. Lee WR. The role of androgen deprivation therapy combined with prostate brachytherapy. Urology 2002; 60 Suppl. 1: 39-44.
25. Salembier C, Henry A, Pieters BR, Hoskin P. A history of transurethral resection of the prostate should not be a contra-indication for low-dose-rate 125I prostate brachytherapy: results of a prospective Uro-GEC phase-II trial. J Contemp Brachytherapy 2020; 12: 1-5.
26. Amin MB, Edge S, Greene FL et al. (Eds.). AJCC Cancer Staging Manual. 8th ed. Springer, 2017.
27. Prebay ZJ, Medairos R, Doolittle J et al. The prognostic value of digital rectal exam for the existence of advanced pathologic features after prostatectomy. Prostate 2021; 81: 1064-1070.
28. Okotie OT, Roehl KA, Han M et al. Characteristics of prostate cancer detected by digital rectal examination only. Urology 2007; 70: 1117-1120.
29. Schoots IG, Padhani AR. Risk-adapted biopsy decision based on prostate magnetic resonance imaging and prostate-specific antigen density for enhanced biopsy avoidance in first prostate cancer diagnostic evaluation. BJU Int 2021; 127: 175-178.
30. Ecke TH, Huanf-Tiel HJ, Golka K et al. Prostate specific antigen (PSA) as predicting marker for clinical outcome and evaluation of early toxicity rate after high-dose rate brachytherapy (HDR-BT) in combination with additional external beam radiation therapy (EBRT) for high risk prostate cancer. Int J Mol Sci 2016; 17: 1879.
31. Drost FJH, Osses DF, Nieboer D et al. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019; 4: CD012663.
32. van Leenders GJLH, van der Kwast TH, Grignon DJ et al. The 2019 International Society of Urological Pathology (ISUP) Consensus Conference on Grading of Prostatic Carcinoma. Am J Surg Pathol 2020; 44: e87-e99.
33. Epstein JI, Amin MB, Fine SW et al. The 2019 Genitourinary Pathology Society (GUPS) White Paper on Contemporary Grading of Prostate Cancer. Arch Pathol Lab Med 2021; 145: 461-493.
34. WHO Classification of Tumours Editorial Board. Urinary and Male Genital Tumours, WHO Classification of Tumours, 5th Edition, Volume 8. IARC Press, Lyon 2022.
35. Kasivisvanathan V, Rannikko AS, Borghi M et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018; 378: 1767-1777.
36. Tu X, Liu Z, Chang T et al. Transperineal magnetic resonance imaging-targeted biopsy may perform better than transrectal route in the detection of clinically significant prostate cancer: Systematic review and meta-analysis. Clin Genitourin Cancer 2019; 17: e860.
37. Corfield J, Perera M, Bolton D et al. (68)Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review. World J Urol 2018; 36: 519-527.
38. Hofman MS, Lawrentschuk N, Francis RJ et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020; 395: 1208-1216.
39. Cattabriga A, Renzetti B, Galuppi F et al. Multiparametric whole-body MRI: A game changer in metastatic prostate cancer. Cancers (Basel) 2024; 16: 2531.
40. Michalski JM, Moughan J, Purdy J et al. Effect of standard vs dose-escalated radiation therapy for patients with intermediate-risk prostate cancer: the NRG oncology RTOG 0126 randomized clinical trial. JAMA Oncol 2018; 4: e180039.
41. Pasalic D, Kuban DA, Allen PK et al. Dose escalation for prostate adenocarcinoma: a long-term update on the outcomes of a phase 3, single institution randomized clinical trial. Int J Radiat Oncol Biol Phys 2019; 104: 790-797.
42. Anderson EM, Kim S, Sandler HM et al. High-dose-rate fractionated brachytherapy monotherapy for localized prostate cancer: A systematic review and meta-analysis. J Contemp Brachytherapy 2021; 13: 365-372.
43. Viani GA, Arruda CV, Assis Pellizzon AC et al. HDR brachytherapy as monotherapy for prostate cancer: A systematic review with meta-analysis. Brachytherapy 2021; 20: 307-314.
44. Corkum MT, Achard V, Morton G et al. Ultrahypofractionated radiotherapy for localised prostate cancer: How far can we go? Clin Oncol 2022; 34: 340-349.
45. Hudson JM, Loblaw A, McGuffin M et al. Prostate high dose-rate brachytherapy as monotherapy for low and intermediate-risk prostate cancer: Efficacy results from a randomized phase II clinical trial of one fraction of 19 Gy or two fractions of 13.5 Gy: A 9-year update. Radiother Oncol 2024; 110381.
46. Tsang YM, Tharmalingam H, Belessiotis-Richards K et al. Ultra-hypofractionated radiotherapy for low-and intermediate-risk prostate cancer: High-dose-rate brachytherapy vs stereotactic ablative radiotherapy. Radiother Oncol 2021; 158: 184-190.
47. Salari K, Hazy AJ, Ye H et al. 21 Gy single fraction prostate HDR brachytherapy: 5-year results of a single institution prospective pilot study. Brachytherapy 2024; 23: 321-328.
48. Nagore G, Moreno-Olmedo E, Suárez-Gironzini V et al. A. Long-term outcomes of ultra-hypofractionated 2 fractions single day HDR brachytherapy in localized prostate cancer. Radiother Oncol 2023; 186: 109807.
49. Nagore G, Lopez Guerra JL, Krumina E et al. High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions. Radiother Oncol 2018; 127: 219-224.
50. Hoskin P, Rojas A, Ostler P et al. Single-dose high-dose-rate brachytherapy versus two and three fractions for locally advanced prostate cancer. Radiother Oncol 2024; 199: 110426.
51. Keyes M, Merrick G, Frank SJ et al. American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy – A systematic literature review. Brachytherapy 2017; 16: 245-265.
52. Spratt DE, Soni PD, McLaughlin PW et al. American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer. Brachytherapy 2017; 16: 1-12.
53. Dayes IS, Parpia S, Gilbert J et al. Long-term results of a randomized trial comparing iridium implant plus external beam radiation therapy with external beam radiation therapy alone in node-negative locally advanced cancer of the prostate. Int J Radiat Oncol Biol Phys 2017; 99: 90-93.
54. Oh J, Tyldesley S, Pai H et al. An updated analysis of the survival endpoints of ASCENDE-RT. Int J Radiat Oncol Biol Phys 2023; 115: 1061-1070.
55. Hoskin PJ, Rojas AM, Bownes P et al. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol 2012; 103: 217-222.
56. Hoskin PJ, Rojas AM, Ostler PJ et al. Randomised trial of external-beam radiotherapy alone or with high-dose-rate brachytherapy for prostate cancer: mature 12-year results. Radiother Oncol 2021; 154: 214-219.
57. Kee DL, Gal J, Falk AT et al. Brachytherapy versus external beam radiotherapy boost for prostate cancer: systematic review with meta-analysis of randomized trials. Cancer Treat Rev 2018; 70: 265-271.
58. Slevin F, Zattoni F, Checcucci E et al. A systematic review of the efficacy and toxicity of brachytherapy boost combined with external beam radiotherapy for nonmetastatic prostate cancer. Eur Urol Oncol 2023; 6: 304-315.
59. Bilski M, Lelek P, Stankiewicz M et al. MUlticentre REtrospective comparison of definitive EBRT with or without HDR BRAchytherapy boost in patients with locally-advanced prostate cancer and regional lymph NOde metastases (MUREBRANO) – A propensity score matched analysis. Radiother Oncol 2025; 212: 111112.
60. Choudhury M, Thomas SS, Cain A et al. Timing of high-dose-rate brachytherapy with external beam radiation therapy in patients with intermediate- and high-risk localized prostate cancer and its effects on toxicity and quality of life: a randomized controlled trial (THEPCA). Int J Radiat Oncol Biol Phys 2024; 119: 90-99.
61. Hetnał M, Romaniszyn A, Serwańska K et al. Prostate inverse brachy boost – 10 Gy with implantation of gold markers – results and feasibility. Radiother Oncol 2023; 182 (Supplement 1).
62. Morton G, Loblaw A, Cheung P et al. Is single fraction 15 Gy the preferred high dose-rate brachytherapy boost dose for prostate cancer? Radiother Oncol 2011; 100: 463-467.
63. Crook J, Cheng JC, Arbour G et al. A randomized comparison of high-dose-rate and low-dose-rate prostate brachytherapy combined with external beam radiation therapy for unfavorable prostate cancer: efficacy results after median follow-up of 74 months. Int J Radiat Oncol Biol Phys 2025; 123: 195-203.
64. Schweizer C, Strnad V, Merten R et al. Prostate brachytherapy boost: Long-term results of protocol-based treatment of patients with non-metastatic prostate cancer. J Contemp Brachytherapy 2024; 16: 391-397.
65. Helou J, D’Alimonte L, Loblaw A et al. High dose-rate brachytherapy boost for intermediate risk prostate cancer: Long-term outcomes of two different treatment schedules and early biochemical predictors of success. Radiother Oncol 2015; 115: 84-89.
66. Patel SA, Kollmeier M, Crook J et al. High-dose-rate (HDR) brachytherapy boost in combination with external beam radiotherapy for localized prostate cancer: An evidence-based consensus statement. Brachytherapy 2025; 24: 644-662.
67. Jackson WC, Hartman HE, Dess RT et al. Addition of androgen-deprivation therapy or brachytherapy boost to external beam radiotherapy for localized prostate cancer: a network meta-analysis of randomized trials. J Clin Oncol 2020; 38: 3024-3031.
68. Joseph D, Denham JW, Steigler A et al. Radiation dose escalation or longer androgen suppression to prevent distant progression in men with locally advanced prostate cancer: 10-year data from the TROG 03.04 RADAR Trial. Int J Radiat Oncol Biol Phys 2020; 106: 693-702.
69. Jones CU, Pugh SL, Sandler HM et al. Adding short-term androgen deprivation therapy to radiation therapy in men with localized prostate cancer: long-term update of the NRG/RTOG 9408 randomized clinical trial. Int J Radiat Oncol Biol Phys 2022; 112: 294-303.
70. Bolla M, Maingon P, Carrie C et al. Short androgen suppression and radiation dose escalation for intermediate- and high-risk localized prostate cancer: Results of EORTC trial 22991. J Clin Oncol 2016; 34: 1748-1756.
71. D’Amico AV, Manola J, Loffredo M et al. 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 2004; 292: 821-827.
72. D’Amico AV, Chen MH, Renshaw AA et al. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA 2008; 299: 289-295.
73. The GEC ESTRO Handbook of Brachytherapy. Chapter 20: Prostate Cancer (2nd ed., 2014).
74. Kirisits C, Rivard M, Baltas D et al. Review of clinical brachytherapy uncertainties; analysis guidelines of the GEC ESTRO and AAPM. Radiother Oncol 2014; 110: 199-212.
75. Duchesne GM, Das R, Toye W, See A. Dose distribution and morbidity after high dose rate brachytherapy for prostate cancer: influence of V150 and V200 parameters. Australas Radiol 2002; 46: 384-389.
76. Michalski JM, Purdy JA, Winter K et al. Preliminary report of toxicity following 3D radiation therapy for prostate cancer on 3DOG/RTOG 9406. Int J Radiat Oncol Biol Phys 2000; 46: 391-402.
77. Crook JM, Potters L, Stock RG et al. Critical organ dosimetry in permanent seed prostate brachytherapy: Defining the organs at risk. Brachytherapy 2005; 4: 186-194.
78. Potter R, Haie Meder C, van Limbergen E et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy – 3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006; 78: 67-77.
79. Hathout L, Folkert MR, Kollmeier MA et al. Dose to the bladder neck is the most important predictor for acute and late toxicity after low-dose-rate prostate brachytherapy: implications for establishing new dose constraints for treatment planning. Int J Radiat Oncol Biol Phys 2014; 90: 312-319.
80. Ben Aicha I, Hathout L, Carignan D et al. Dose to the bladder neck is not correlated with urinary toxicity in patients with prostate cancer treated with HDR brachytherapy boost. Brachytherapy 2020; 19: 584-588.
81. Rasmusson E, Gunnlaugsson A, Wieslander E. Erectile dysfunction and absorbed dose to penile base structures in a randomized trial comparing ultrahypofractionated and conventionally fractionated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2020; 107: 143-151.
82. Roach M 3rd, Nam J, Gagliardi G et al. Radiation dose-volume effects and the penile bulb. Int J Radiat Oncol Biol Phys 2010; 76 (3 Suppl): S130-134.
83. Brand DH, Brüningk SC, Wilkins A et al. Estimates of Alpha/Beta (α/β) Ratios for Individual Late Rectal Toxicity Endpoints: An Analysis of the CHHiP Trial. Int J Radiat Oncol Biol Phys 2021; 110: 596-608.
84. Fiorino C, Cozzarini C, Rancati T et al. Modelling the impact of fractionation on late urinary toxicity after postprostatectomy radiation therapy. Int J Radiat Oncol Biol Phys 2014; 90: 1250-1257.
Copyright: © 2026 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
  
Termedia
About us Contact
Copyright notice Privacy policy Advertising policy Contact us
Quick links
Journals Books eBooks Events
© 2026 Termedia Sp. z o.o.
Developed by Termedia.