Can we afford prostate permanent seed brachytherapy as monotherapy in Gleason score 7 prostate cancer patients?

After permanent prostate seed implant (PPI) as a monotherapy, biochemical failure may occur in 20% to 30% of low or intermediate-risk prostate cancer patients. These rates are very similar to the rates of biochemical failures observed with surgery or external radiotherapy with respect to each prognostic group. It should be noted that the rates of pure intraprostatic failures remain lower. The review of the literature shows that PPI is allowed for Gleason 7 cancers in patients with favorable intermediate-risk with respect to an accurate selection of patients. Indeed, the latest recommendations from the American Brachytherapy Society (ABS) are in keeping with such assumption and ABS allows PPI for intermediate-risk patients. However, it is not recommended to use PPI as a monotherapy in patients with several intermediate-risk prognostic factors (Gleason score 7 (3 + 4) or clinical T2b or a PSA value between 10 and 20 ng/mL). (C) 2013 Published by Elsevier Masson SAS.