Renal + Urology NewsSBRT May Reduce PSA Failure vs HDR Brachytherapy in Intermediate-Risk Prostate Cancer

In a pooled analysis of 5 prospective trials, SBRT outperformed HDR brachytherapy monotherapy across key outcomes in intermediate-risk prostate cancer. At 10 years, biochemical failure reached 38% with HDR-BT versus 10.4% with SBRT, a difference that should reshape radiation modality conversations for this population.

Clinical Considerations

• 10-year biochemical failure was nearly 4x higher with HDR-BT than SBRT (38% vs 10.4%; P < .001)
• Acute grade 2+ genitourinary adverse events occurred in 74.6% of HDR-BT patients versus 51.7% with SBRT (P = .007)
• Late quality of life and late adverse events showed no significant difference between modalities
• SBRT cohort carried higher baseline disease burden (62% unfavorable intermediate-risk vs 39% HDR-BT), making SBRT’s superiority more striking

Practice Applications

• Prioritize SBRT over HDR-BT monotherapy for intermediate-risk prostate cancer referrals
• Counsel patients that SBRT carries significantly lower acute GU toxicity risk
• Document modality selection rationale given long-term biochemical control differences
• Revisit HDR-BT referral patterns with radiation oncology partners using this 10-year data

More in Prostate Cancer