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Is There a Place for Interventional Radiotherapy (Brachytherapy) in Prostate Cancer?

 

ESTRO 2026 Congress Report I Brachytherapy track

At ESTRO 2026 in Stockholm, held from 15 to 19 May under the theme “Innovating Radiation Oncology, Together,” the prostate brachytherapy track showed that Interventional Radiotherapy remains a relevant and evolving component of prostate cancer care rather than a legacy technique. Across the meeting, the material consistently positioned brachytherapy as a modality with continuing value in definitive treatment, dose escalation with external-beam radiotherapy, and salvage therapy after prior irradiation.

The programme highlighted both HDR and LDR brachytherapy. On 16 May, physics and innovation sessions emphasised technical refinement, including electromagnetic tracking, motion compensation, anatomical referencing, and next-generation precision concepts for prostate HDR brachytherapy. These topics suggest that the field is not standing still; instead, it is becoming more image-guided, more adaptive, and more workflow-driven.

 On 17 May, workflow optimisation discussions stressed three practical pillars for wider implementation: AI automation, dose optimisation, and integrated guidance with personalisation.

Clinical presentations strengthened the argument that Interventional Radiotherapy (brachytherapy) still matters. LDR data presented in long-term series showed durable biochemical control and generally low severe toxicity, supporting its established role in selected low- and favourable intermediate-risk disease. Additional clinical material reported more than a decade of tumour control after LDR implants, while also acknowledging transient urinary deterioration and the need for careful toxicity counselling. This reinforces the consensus that LDR brachytherapy remains important as a mature curative option, especially when long-term local control is a priority.

HDR brachytherapy appeared especially important in three settings. First, as primary treatment, monotherapy studies and phase II updates indicated sustained disease control with acceptable toxicity, including single-fraction approaches under prospective evaluation. Second, as a boost combined with EBRT or SBRT, several abstracts supported HDR as a powerful dose-escalation tool, with favourable biochemical control and manageable quality-of-life impact in appropriately selected patients. Third, in the salvage setting, MR-assisted whole-gland and focal salvage HDR, while the treatment of isolated seminal vesicle relapse showed that brachytherapy offers a realistic local option even after previous radiotherapy.

A second clear message from ESTRO 2026 was that Interventional Radiotherapy (brachytherapy) is increasingly being judged against advanced external-beam techniques such as SBRT and MR-linac ultra-hypofractionation. Some comparisons suggested similar disease control but differences in urinary quality of life, meaning the future role of brachytherapy will depend not only on oncologic outcomes but also on patient selection, toxicity mitigation, and technical excellence. Overall, the ESTRO 2026 prostate brachytherapy track supports a clear conclusion: Interventional Radiotherapy (brachytherapy), whether HDR or LDR, still has an important place in prostate cancer treatment, particularly as a high-precision option for primary therapy, boost strategies, and salvage treatment

Overview of presentations

The following speakers and titles were listed in the ESTRO 2026 prostate brachytherapy-related track as provided in the meeting programme summary.

  • Ioannis Androulakis — Advanced Electromagnetic Tracking with a Foley-Based Reference Sensor for Motion Compensation and Anatomical Referencing in Prostate HDR Brachytherapy.
  • Iosif Stouthos — Prostate precision: Next-gen brachytherapy breakthroughs focusing.
  • Justinas Jonušas— Brachytherapy workflow optimisation in prostate cancer.
  • William Hayhurst — Long-Term Survival and Toxicity Outcomes in Over 1,200 Men Aged ≤60 Years Treated with LDR Brachytherapy.
  • Lucas Mendez — Quality-of-Life Outcomes in Prostate HDR Brachytherapy plus UH-WPRT vs. SBRT plus UH-WPRT: An Inter-Trial Comparison of HOPE and ARGOS.
  • Mariana Borras-Osorio — Comparative Effectiveness of HDR Brachytherapy versus SBRT for Localised Prostate Cancer: A Propensity Score Matched Study.
  • Hans Chung — An updated analysis of MR-assisted whole-gland salvage HDR prostate brachytherapy with intra-prostatic boost: a prospective study.
  • Catherine Frank — Automated needle reconstruction in HDR prostate brachytherapy via a commercially compatible 3D-printed TRUS sleeve with integrated EM tracking sensors.
  • Laura Zaragoza Cocero — SBRT with HDR boost vs SBRT alone: a prospective comparative analysis of side effects, quality of life and disease control.
  • David Quigley — From Seeds to SABR: Insights from LDR Brachytherapy Dose Patterns to Guide Prostate Focal Boost Strategies.
  • Alai Goñi Ramirez— CT-based versus TRUS-based High-Dose-Rate brachytherapy boost in prostate cancer: long-term oncological outcomes.
  • Marnix Rasing — Oncologic outcome and toxicity after focal salvage HDR brachytherapy in locally recurrent prostate cancer after radiotherapy.
  • Miren Gaztañaga — Long-term outcomes of HDR brachytherapy as monotherapy for localised prostate cancer: a single-institution experience.
  • Javier Vijande — Permanent implant prostate brachytherapy 3D dosimetric reference datasets for model-based dose calculations.
  • Joel Beaudry — Artificial Intelligence-Based Nomogram to Predict Achievable Dose Coverage in HDR Prostate Brachytherapy.
  • Luc Beaulieu — Uncovering planning patterns and dosimetric trends in permanent prostate brachytherapy: A comprehensive Monte Carlo-based multi-institutional analysis.
  • Marie-Colombe Schmittbiel — Ten-year outcomes of single-fraction HDR brachytherapy for prostate cancer: Results from the SiFEPI phase II prospective trial.
  • Koji Inaba — Prospective phase II multicenter trial of high-dose-rate brachytherapy for prostate cancer.
  • Max Peters — Higher patient-reported urinary toxicity after I-125 brachytherapy vs MR-linac ultra-hypofractionation in low–intermediate-risk prostate cancer.
  • Konstantinos Ferentinos — HDR brachytherapy vs SBRT for localised prostate cancer: exploratory analysis of longitudinal QoL and PSA kinetics.
  • Tracy Lim Yew Fai — Focal salvage high dose rate brachytherapy for isolated seminal vesicle relapse of prostate cancer.
  • Carlton Johnny — Focal MR-Guided HDR Brachytherapy Boost Combined with SBRT for Localised Prostate Cancer.
  • Kanta KA — Ten-year outcomes after single-fraction HDR brachytherapy boost plus EBRT for localised prostate cancer.

 

 

Dr Hathal Haddad

Head of Interventional Radiotherapy & Brachytherapy Unit

Department of Radiation Oncology

University Hospital of Tübingen & Medical Faculty

Tübingen, Germany

LinkedIn: https://www.linkedin.com/in/hathalhaddad/
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Email: hathal.haddad@med.uni-tuebingen.de