1. Real-Time Brachytherapy Planning - this involves creating a brachytherapy treatment time right at the time of the procedure. The tradtional technique involves creating a brachytherapy plan prior to the procedure based on images of the prostate before the procedure. Real time brachytherapy planning is created at the time of the procedure based on the images of the prostate of what it looks like that day. This is a big deal since the prostate can change in size and shape so the real time planning allows for maximum precision.
2. Rectal Spacing- There are now products that have the ability to create a space (or barrier) between the prostate and rectum so that the rectum is protected from the radiation (internal or external) to the prostate. There is now significant reduction in GI toxicity such as rectal bleeding when rectal spacing is used for men undergoing radiation therapy for prostate cancer. Currently there are two products SpaceOAR and Barrigel which can be used for rectal spacing which is performed under transrectal ultrasound guidance via transperineal approach just like LDR prostate brachytherapy. Rectal spacing can be performed before or at the same time of LDR brachytherapy.