One must remember that most patients are treated in smaller community hospitals. These low-volume centers may have difficulty consistently achieving high-quality LDR implants regardless of the technique used. Suboptimal LDR implants result in higher biochemical failure rates (2). However, with HDR’s postneedle placement CT planning one can usually correct for suboptimal needle placement and consistently achieve high-quality dosimetry (3). In terms of patient convenience LDR wins. But the two nights in the hospital needed for HDR monotherapy certainly compare favorably with radical prostatectomy or 8 weeks of daily external beam radiation therapy. The issue that patients are most concerned about is toxicity. I do not think we can assume that HDR is superior to LDR in terms of impotency based on the one study from William Beaumont, but this study is intriguing. Rectal toxicity is very low with both LDR and HDR patients, so proctitis will not be a deciding toxicity factor either. Acute urinary side effects are higher in the LDR patients, as noted in the study by Gillis that directly and prospectively compared healthrelated quality of life in HDR monotherapy and LDR monotherapy patients. HDR patients have a significantly lower incidence of acute urinary retention and dysuria than LDR patients, and in my experience less urge incontinence the first few weeks after implant. Thus, at this point in time, HDR monotherapy seems promising in terms of both efficacy and toxicity. More confirmatory studies with longer followup need to be reported before HDR monotherapy will be generally accepted as an alternative to LDR monotherapy outside a study setting.