Post hoc pooled analysis of five prospective trials of stereotactic body radiotherapy versus high-dose-rate brachytherapy for intermediate-risk prostate cancer

Stereotactic body radiotherapy (SBRT) and high-dose-rate brachytherapy monotherapy (HDR-BT) are options for intermediate-risk prostate cancer. Analysis of pooled individual patient data from 5 prospective trials compared outcomes after SBRT versus HDR-BT. 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. The analysis included 247 men, with a median follow-up of 9.5 years (IQR 5.5-10.6), of whom 180 underwent SBRT and 67 underwent HDR-BT. HDR-BT was associated with worse biochemical failure and a significantly higher incidence of acute grade 2 or higher genitourinary adverse events versus SBRT. The authors conclude that, compared to HDR-BT, SBRT was associated with better outcomes among men with intermediate-risk prostate cancer.