The purpose of this study was to evaluate the efficacy of multisolutions optimization algorithm for High Dose Rate (HDR) brachytherapy of prostate. In this retrospective study, we included data from 20 prostate cancer patients who underwent ultrasound based real time HDR Brachytherapy at institution. The treatment plans of all 20 patients were optimized in Oncentra Prostate treatment planning system (TPS) using inverse dose volume histogram based optimization followed by graphical optimization (GRO) in real time. The data of all the patients were retrieved later, and the treatment plans were re-optimized using multisolutions dose volume histogram based optimization (MDVHO) and multisolutions variance based optimization (MVBO) algorithms with same set of dose constraints, same number of catheters, and same contour set as in GRO. Several Pareto optimal solutions were obtained by varying the weighting factors of composite objective function in finite steps of adequate resolutions. These solutions were then stored in the database of TPS and same decision criteria was employed to pick the final solution using a decision engine. The average values for planning target volume receiving 100% of prescribed dose (V100) for MDVHO, MVBO, and GRO were 95.03%, 86.72% and 97.56%, respectively. The average V100 due to MDVHO was statistically significant (P = 0.002) in comparison to MVBO, whereas the average V100 due to MDVHO and GRO was not statistically significant (P = 0.066). In conclusion, the MDVHO can provide comparable solutions to typical clinical optimizations using GRO within clinically reasonable amount of time. In most of the cases, the plans created by MVBO were not clinically acceptable without users’ further manual intervention
