Brachytherapy boosts in combination with external-beam radiation therapy al
low a highly conformal dose of radiation to be delivered to the prostate in
a safe, efficient manner: Several types of brachytherapy boost techniques
are used currently. Techniques based on transrectal ultrasound (TRUS) guida
nce clearly provide the most accurate method of radioactive source placemen
t with reduced toxicity. Temporary implants employing remote afterloading s
ystems with high-dose-rate (HDR) brachytherapy offer the added advantage of
further optimizing dose distribution after needle placement. Novel brachyt
herapy programs using intraoperative real-time dosimetric analyses provide
additional options for performing truly conformal dose escalation. Results
with these newer boost techniques appear to be as good as or better than ot
her forms of therapy in comparably staged patients, Until standardized meth
ods of reporting treatment data are uniformly applied and longer follow-up
is obtained with other treatment modalities, brachytherapy boosts combined
with external-beam radiation should be considered art acceptable treatment
option for patients with locally advanced prostate cancer. The challenge fo
r the future will be to determine which treatment approach is optimal given
certain critical pretreatment prognostic factors. In addition, the role of
adjuvant androgen deprivation in controlling this malignancy will be criti
cal and awaits the results of several recently initiated or completed rando
mized trials.