@jeffmarc In the European Society for Radiation Therapy and Oncology guidelines
https://www.thegreenjournal.com/action/showPdf
Published 2022

Under a headline “Indications”: “Detailed patient selection criteria have been previously published.. In addition to ensuring that there are no detectable metastases, good urinary function and predicted life expectancy of >10 years several new concepts have emerged:

i) Gland size: previous guidelines have recommended limits of 50–60 ml however for both LDR and HDR, if there is minimal pubic arch interference, there is now published data showing that much larger glands can be successfully implanted with good results for both dosimetry and biochemical control with no excess toxicity [5,6].”

Footnotes 5 and 6:

5. Le, H. ∙ Rojas, A. ∙ Alonzi, R. … The influence of prostate volume on outcome after high-dose-rate brachytherapy alone for localized prostate cancer https://www.redjournal.org/article/S0360-3016(13)00554-3/abstract
“Conclusion: Prostate gland size does not affect dosimetric parameters in HDR-BT assessed by D90 and V100. In patients with larger glands, a significantly higher biochemical control of disease was observed, with no difference in late toxicity. This improvement cannot be attributed to differences in dosimetry. Gland size should not be considered in the selection of patients for HDR-BT.”

6. Stone, N.N. ∙ Stock, R.G. Prostate brachytherapy in men with gland volume of 100cc or greater: technique, cancer control, and morbidity https://www.thegreenjournal.com/servlet/linkout
“Conclusion: This study demonstrates the feasibility of implanting patients with PV100. Very large PV does not influence bFFF. Although urinary retention rates were higher, the long-term urinary symptoms were no different between the two groups. Requirement for transurethral resection of the prostate was no higher in patients with PV100. Radiation proctitis rates were similar for both.”