Low dose rate (LDR) brachytherapy has rapidly gained popularity in the USA [1, 2] and Europe [3, 4] as an accepted, effective and safe therapy for localized prostate cancer. Many reports are now available which confirm good outcomes in selected patients with PSA relapse-free survivals that are equivalent to those achieved by surgery.

The potential for a therapy that is equally efficient but less harmful than other interventions is especially attractive for patients with early prostate cancer.

On the other hand, treatment with temporary high dose rate (HDR) brachytherapy with 192-Ir as monotherapy has a number of advantages compared to LDR. The overall treatment time is decreased from many months with LDR to several minutes with HDR. Besides, HDR improves the dose distribution because of the possibility of accurately controlling the source and vary the source dwell time during treatment. The intraoperative optimization used with HDR allows better source position targeting with the potential for limiting toxicity. There are also advantages in radiation safety for both staff and patient who leave the treatment room without any radioactive implants.

The purpose of this chapter was to determine the possibility to treat patients with favorable stage prostate cancer (5, 6) with HDR monotherapy in one fraction and transperineal hyalur-onic acid injection into the perirectal fat.

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