Global practice patterns in prostate brachytherapy: Results from the ENCOMPASS survey.

PURPOSE: To characterize global practice patterns in prostate brachytherapy (BT) and evaluate variation in practice, identifying alignment with guidelines and opportunities for harmonization.

METHODS AND MATERIALS: A 75-item survey was distributed via international BT societies. One response per institution was requested, completed by a radiation oncologist and medical physicist. Domains included departmental characteristics, BT utilization, prescriptions, imaging, planning, verification, and salvage practices. Data were summarized descriptively.

RESULTS

A total of 116 institutions responded (64.1%), mainly from North America and Europe. Most had >10 years' experience, though case volumes were modest (11-50 de novo; <10 salvage annually). High-dose-rate (HDR) BT was most used for combination and salvage, while HDR and low-dose-rate BT were evenly used for monotherapy. Prescription regimens were heterogeneous, particularly for HDR monotherapy and salvage. Androgen-deprivation therapy duration varied across risk groups. Transrectal ultrasound was the primary planning modality; only 46% used fused diagnostic imaging for intraprostatic lesion definition. Most used ≤3 mm margins and standard coverage metrics, though organ-at-risk constraints varied. Focal BT use was increasing, particularly in salvage settings.

CONCLUSIONS

Substantial international variability exists across BT practice. While core technical principles are consistent, heterogeneity highlights the need for harmonized guidelines, prospective studies, and global collaboration.