The clinical results from 12 Swiss centres reaffirm the benefits of low‐dose‐rate brachytherapy (LDR‐BT) for the treatment of localised prostate cancer [1]. The authors are to be commended for collating and analysing prospective, countrywide, long‐term data. This is an excellent example of ‘Good Clinical Practice’ for the urology community, patients, commissioning groups and for governance purposes. Prostate brachytherapy offers suitable men with prostate cancer a high chance of long‐term cure, but with a low risk of urinary incontinence and most retaining erectile function [2].

Two‐thirds of the patients reported in the Swiss series had low‐risk prostate cancer, who would now more commonly be offered active surveillance as an initial treatment option. However, our own and other large mature series have shown similar treatment efficacy of LDR‐BT, either as monotherapy as in the Swiss study, or as a boost to external‐beam radiotherapy, for the treatment of patients with intermediate and high risk of disease relapse [3, 4]. Indeed the ASCENDE‐RT (Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy) trial recently showed that men with unfavourable intermediate‐ or high‐risk prostate cancer randomised to an LDR‐BT boost arm, relative to a dose‐escalated external‐beam radiotherapy boost, were twice as likely to be free of biochemical failure at a median follow‐up of 6.5 years. A slight increase in urinary toxicity was observed, which may have been an issue related to implant technique [5].

The authors show that LDR‐BT affords excellent disease control, which associates with post‐implant dosimetry in keeping with current treatment guidelines. They also report an association between biochemical control and seed loss. It therefore becomes unclear the extent to which implant quality or implant technique, i.e., the use of loose or stranded seeds, influenced the oncological outcome, as it would appear that more than one BT technique has been used.

In this series no prostate cancer‐related deaths were reported. However, the median follow‐up length of 37 months is relatively short. Examples from more mature series show longer follow‐up is needed to begin to document the low rates of prostate cancer‐related deaths following LDR‐BT. Lazarev et al. [6] in a similar risk group distribution to the Swiss population, reported 97% prostate cancer‐specific survival at 17 years, with all deaths occurring >10 years after treatment. Morris et al. [4] reported 99.1% cause‐specific survival at 10 years, with death events 9 years after treatment in low‐ and intermediate‐risk disease. Our own series showed 98% prostate cancer‐specific survival at 7 and 9 years post‐implantation in high‐risk (as defined by National Institute for Health and Care Excellence [NICE]) patients treated with monotherapy [3].

Treatment‐related toxicity assessments in the Swiss series showed that baseline values are crucial to understand the impact of treatment on patient‐reported outcomes. Higher post‐implant scores were consistently observed in those patients with higher baseline scores. The patient‐reported outcomes were similar to those from our series where sexual potency was preserved in 70–80% of men who were aged ≤60 years at the time of implantation [7].

Salvage therapies are seldom given after LDR‐BT, as the local failure rate is low and the surgery complex. It was undertaken in only two patients in the Swiss series. In the era of multiparametric‐MRI and prostate‐specific membrane antigen positron emission tomography/CT scans and targeted biopsies, tumour recurrence can be better assessed. Salvage surgery has been offered to ~0.5% (27/4200) of our patients, by either robot‐assisted radical prostatectomy or seminal vesiculectomy, if the recurrence is localised to the seminal vesicle alone.

This nation‐wide report from the 12 Swiss centres is a welcome addition to the extensive body of evidence that attests to the excellent results and generalisability of prostate LDR‐BT. The treatment is efficacious and convenient for patients with a low toxicity profile. It is a cost‐effective option that should be offered to all suitable patients with localised prostate cancer.

瑞士12个中心的临床结果再次证实了低剂量率近距离放射治疗（LDR-BT）对于局部前列腺癌的治疗[ 1 ]。应当赞扬作者整理和分析全国范围的长期长期数据。这是泌尿外科社区，患者，委托小组和治理目的“良好临床实践”的一个很好的例子。前列腺近距离放射疗法为患有前列腺癌的男性提供了长期治愈的机会，但其尿失禁的风险也较低，而且勃起功能最多。[ 2 ]

Swiss系列中报告的患者中有三分之二患有低危前列腺癌，现在更通常将接受主动监测作为初始治疗选择。但是，我们自己的和其他大型成熟系列药物已显示出LDR-BT的治疗效果与瑞士研究中的单药治疗或对体外放射疗法的增强疗效相似，可用于治疗中度和高危疾病患者复发[ 3，4]。确实，ASCENDE‐RT（雄激素抑制联合选择性淋巴结和剂量递增放射疗法）试验最近显示，患有中度或高危前列腺癌的男性相对于剂量递增的外用药随机分配到LDR‐BT加强组在6.5年的中位随访中，无放射化学治疗的可能性是生化失败的两倍。观察到泌尿毒性略有增加，这可能是与植入技术有关的问题[ 5 ]。

作者表明，LDR-BT具有出色的疾病控制能力，与种植后剂量测定法相关联，符合当前的治疗指南。他们还报告了生化控制与种子损失之间的关联。因此，目前尚不清楚植入质量或植入技术（即使用散落或滞留的种子）在多大程度上影响了肿瘤学结果，因为似乎已经使用了一种以上的BT技术。

在该系列中，没有报告与前列腺癌相关的死亡。但是，中位随访期为37个月，相对较短。来自更成熟系列的示例显示，需要更长的随访时间才能开始记录LDR-BT后与前列腺癌相关的死亡率较低。拉扎列夫等。[ 6 ]在与瑞士人群类似的危险人群中，据报道在17岁时97％的前列腺癌特异性存活，所有死亡发生在治疗后10年以上。莫里斯等。[ 4]报告中低危和中危疾病治疗10年后有99.1％的原因特异性存活率，9年后有死亡事件发生。我们自己的系列结果显示，接受单一疗法治疗的高危（根据美国国立卫生与医疗保健研究院[NICE]定义）的高危患者在植入后7年和9年时的前列腺癌特异性生存率为98％[ 3 ]。

Swiss系列中与治疗有关的毒性评估表明，基线值对于了解治疗对患者报告的结局的影响至关重要。在基线评分较高的患者中，始终观察到较高的植入后评分。患者报告的结局与我们系列中的结果相似，即在植入时≤60岁的男性中，有70％至80％的男性保留了性能力[ 7 ]。

LDR-BT后很少进行抢救疗法，因为局部失败率低且手术复杂。瑞士系列仅对两名患者进行了此项研究。在多参数MRI和前列腺特异性膜抗原正电子发射断层扫描/ CT扫描和靶向活检的时代，可以更好地评估肿瘤的复发。如果复发仅局限于精囊，则可通过机器人辅助根治性前列腺切除术或精囊切除术为约0.5％（27/4200）的患者提供挽救手术。

来自12个瑞士中心的这份全国性报告是对大量证据的可喜补充，这些证据证明了前列腺LDR-BT的出色结果和通用性。对于低毒性曲线的患者，该治疗有效且方便。这是一种经济有效的选择，应该提供给所有适合的局部前列腺癌患者。