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.