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SBRT vs HDR Brachytherapy for Intermediate-Risk Prostate Cancer
Cristian Udovicich1,2,3, Patrick Cheung1,2, William Chu1,2
1Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
JAMA Network Open
|February 25, 2026
Summary
Stereotactic body radiotherapy (SBRT) demonstrated superior outcomes compared to high-dose-rate brachytherapy (HDR-BT) for intermediate-risk prostate cancer, showing lower biochemical failure and fewer genitourinary side effects. Quality of life was comparable between the two treatments.
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.
