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SBRT vs HDR Brachytherapy for Intermediate-Risk Prostate Cancer.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urology

Background:

  • Stereotactic body radiotherapy (SBRT) and high-dose-rate brachytherapy (HDR-BT) are established monotherapy options for intermediate-risk prostate cancer.
  • Prospective comparative data between SBRT and HDR-BT for this patient population are limited.

Purpose of the Study:

  • To compare biochemical failure (BCF), patient-reported quality of life (PR-QoL), and adverse events (AEs) between SBRT and HDR-BT in intermediate-risk prostate cancer using prospective data.
  • To provide long-term comparative outcomes for these two treatment modalities.

Main Methods:

  • A post hoc pooled analysis of 5 prospective trials involving men with intermediate-risk prostate cancer treated with either SBRT or HDR-BT without androgen deprivation therapy.
  • Data were collected from 2010 to 2018, with statistical analyses performed in September 2024.

Main Results:

  • The analysis included 247 men (180 SBRT, 67 HDR-BT) with a median follow-up of 9.5 years.
  • High-dose-rate brachytherapy (HDR-BT) was associated with significantly higher biochemical failure (BCF) at 5 and 10 years compared to stereotactic body radiotherapy (SBRT).
  • The HDR-BT cohort experienced a higher incidence of acute grade 2 or greater genitourinary adverse events (AEs) than the SBRT cohort.

Conclusions:

  • Stereotactic body radiotherapy (SBRT) demonstrated significantly lower biochemical failure (BCF) and fewer acute genitourinary adverse events (AEs) compared to high-dose-rate brachytherapy (HDR-BT) in intermediate-risk prostate cancer.
  • No significant differences were observed in late adverse events or patient-reported quality of life between SBRT and HDR-BT.
  • This study provides valuable long-term prospective evidence supporting SBRT over HDR-BT for intermediate-risk prostate cancer regarding efficacy and toxicity.