SBRT vs HDR Brachytherapy for Intermediate-Risk Prostate Cancer.
[IMPORTANCE] Stereotactic body radiotherapy (SBRT) and high-dose-rate brachytherapy monotherapy (HDR-BT) are options for intermediate-risk prostate cancer.
- p-value P < .001
- p-value P = .007
APA
Udovicich C, Cheung P, et al. (2026). SBRT vs HDR Brachytherapy for Intermediate-Risk Prostate Cancer.. JAMA network open, 9(2), e260146. https://doi.org/10.1001/jamanetworkopen.2026.0146
MLA
Udovicich C, et al.. "SBRT vs HDR Brachytherapy for Intermediate-Risk Prostate Cancer.." JAMA network open, vol. 9, no. 2, 2026, pp. e260146.
PMID
41739470
Abstract
[IMPORTANCE] Stereotactic body radiotherapy (SBRT) and high-dose-rate brachytherapy monotherapy (HDR-BT) are options for intermediate-risk prostate cancer. However, no prospective evidence is available to compare these modalities.
[OBJECTIVE] To compare the biochemical failure (BCF), late patient-reported quality of life (PR-QoL), and acute and late adverse events (AEs) associated with SBRT and HDR-BT using prospective data.
[DATA SOURCES] This was an individual patient data post hoc pooled analysis of 5 prospective trials with recruitment from 2010 to 2018. Statistical analyses were performed in September 2024.
[STUDY SELECTION] This was a post hoc analysis of these 5 sprospective trials. Eligibility criteria comprised men with intermediate-risk prostate cancer undergoing 5- or 2-fraction SBRT or 2-fraction HDR-BT. No androgen deprivation therapy was permitted.
[DATA EXTRACTION AND SYNTHESIS] Baseline patient and clinicopathological characteristics were requested.
[MAIN OUTCOMES AND MEASURES] BCF, a minimal clinically important change on the PR-QoL, and clinician-reported AEs were the main outcomes.
[RESULTS] After a median (IQR) follow-up of 9.5 (5.5-10.6) years, 247 men met the eligibility criteria, including 180 men undergoing SBRT (72.8%; mean [SD] age, 69.5 [6.7] years) and 67 men undergoing HDR-BT (27.1%; mean [SD] age, 66.0 [6.5] years). HDR-BT was associated with increased BCF. At 5 years, BCF was 7.8% (95% CI, 1.0%-14.6%) for HDR compared with 3.0% (95% CI, 0.4%-5.6%) for SBRT. At 10 years, BCF was 38.0% (95% CI, 19.8%-56.1%) for HDR compared with 10.4% (95% CI, 4.3%-16.6%) for SBRT (P < .001). The HDR-BT cohort had a significantly higher incidence of acute grade 2 or greater genitourinary AEs compared with SBRT (50 men [74.6%] vs 31 men [51.7%]; P = .007). There were no significant differences in any other acute or late AEs or late PR-QoL.
[CONCLUSIONS AND RELEVANCE] This post hoc pooled analysis reports a long-term comparison of SBRT and HDR-BT using prospective data. SBRT had significantly lower BCF and acute genitourinary AEs, and there was no significant difference in late PR-QoL.
[OBJECTIVE] To compare the biochemical failure (BCF), late patient-reported quality of life (PR-QoL), and acute and late adverse events (AEs) associated with SBRT and HDR-BT using prospective data.
[DATA SOURCES] This was an individual patient data post hoc pooled analysis of 5 prospective trials with recruitment from 2010 to 2018. Statistical analyses were performed in September 2024.
[STUDY SELECTION] This was a post hoc analysis of these 5 sprospective trials. Eligibility criteria comprised men with intermediate-risk prostate cancer undergoing 5- or 2-fraction SBRT or 2-fraction HDR-BT. No androgen deprivation therapy was permitted.
[DATA EXTRACTION AND SYNTHESIS] Baseline patient and clinicopathological characteristics were requested.
[MAIN OUTCOMES AND MEASURES] BCF, a minimal clinically important change on the PR-QoL, and clinician-reported AEs were the main outcomes.
[RESULTS] After a median (IQR) follow-up of 9.5 (5.5-10.6) years, 247 men met the eligibility criteria, including 180 men undergoing SBRT (72.8%; mean [SD] age, 69.5 [6.7] years) and 67 men undergoing HDR-BT (27.1%; mean [SD] age, 66.0 [6.5] years). HDR-BT was associated with increased BCF. At 5 years, BCF was 7.8% (95% CI, 1.0%-14.6%) for HDR compared with 3.0% (95% CI, 0.4%-5.6%) for SBRT. At 10 years, BCF was 38.0% (95% CI, 19.8%-56.1%) for HDR compared with 10.4% (95% CI, 4.3%-16.6%) for SBRT (P < .001). The HDR-BT cohort had a significantly higher incidence of acute grade 2 or greater genitourinary AEs compared with SBRT (50 men [74.6%] vs 31 men [51.7%]; P = .007). There were no significant differences in any other acute or late AEs or late PR-QoL.
[CONCLUSIONS AND RELEVANCE] This post hoc pooled analysis reports a long-term comparison of SBRT and HDR-BT using prospective data. SBRT had significantly lower BCF and acute genitourinary AEs, and there was no significant difference in late PR-QoL.
MeSH Terms
Humans; Male; Prostatic Neoplasms; Brachytherapy; Radiosurgery; Aged; Quality of Life; Middle Aged; Prospective Studies