Onkologie. 2025:19(4):223-229 | DOI: 10.36290/xon.2025.042

Brachytherapy for prostate cancer in 2025: Present landscape, key challenges, and perspectives for the future

Miroslav Hodek, Denisa Pohanková, Petr Paluska, Linda Kašaová, Jakub Grepl, Jiří Petera, Igor Sirák

Klinika onkologie a radioterapie, FN Hradec Králové

Introduction: Brachytherapy is one of the key curative modalities in the treatment of localized prostate cancer, enabling the delivery of high-dose ionizing radiation directly into the prostate tissue while relatively sparing surrounding organs. Over the past three decades, significant technological and clinical advances have reshaped its indications, technical implementation, and outcomes. Nevertheless, the utilization of brachytherapy remains uneven across countries and institutions, and the method still faces multiple challenges, both technical and organizational.

Objective: The aim of this review article is to provide a comprehensive and up-to-date overview of the role of prostate brachytherapy in 2025. It summarizes the key technological and clinical aspects of the method, identifies current limitations, and discusses future directions in the context of modern oncology.

Methods: This narrative review is based on an analysis of relevant scientific literature published between 2013 and 2025, retrieved from PubMed, Scopus, and Web of Science. Included sources comprise randomized clinical trials, systematic reviews, observational cohorts, and international clinical guidelines (EAU, ESTRO, ASTRO, NCCN, ASCO). Emphasis was placed on data related to indications, dose regimens, planning technologies, clinical outcomes, and treatment-related toxicity.

Results: Brachytherapy is currently categorized into two main approaches: LDR-BT (permanent seed implantation) and HDR-BT (temporary, fractionated application), each with specific clinical indications, logistical requirements, and dose strategies. Modern image-guided and real-time planning techniques - including TRUS, CT, multiparametric MRI, and intraoperative adaptation - have significantly improved the precision of source placement and reduced both acute and late toxicities. Clinical studies show that, in selected patient groups, brachytherapy achieves oncologic outcomes comparable to, or even exceeding, those of radical prostatectomy or external beam radiotherapy (EBRT). However, key limitations remain, including methodological inconsistencies between studies, a lack of randomized controlled trials, limited long-term data on toxicity and quality of life, and substantial regional disparities in access to care.

Conclusion: As of 2025, prostate brachytherapy remains a well-established, highly effective, and technically sophisticated treatment modality for localized prostate cancer. It plays a central role as monotherapy for low-risk patients and in combination with EBRT for those with intermediate and high-risk disease. The future of brachytherapy lies in deeper integration of personalized medicine-through the use of genomic and radiomic biomarkers, AI-supported planning, and robust multicenter data registries. Ensuring equal access to this effective treatment will depend on further technological standardization, interdisciplinary cooperation, and systemic support for its broader implementation in clinical practice.

Keywords: prostate cancer, brachytherapy, LDR, HDR, radiotherapy, treatment planning.

Accepted: September 30, 2025; Published: October 8, 2025  Show citation