Top Line: Two definitive radiation treatments for intermediate risk prostate cancer standout for patient convenience: ultra-hypofractionated external beam radiation and stand-alone brachytherapy.
The Study: In this pooled analysis of individual patient data (n=247) across 5 prospective trials, investigators compared ultra-hypofrac over 2-5 treatments (n=180) versus 2-fraction high-dose-rate (HDR) brachy (n=67) for intermediate-risk prostate cancer receiving no ADT. Median follow-up approached ten years. Despite the ultra-frac cohort harboring more unfavorable features (62% vs 39%), biochemical failure was significantly higher with HDR-brachy at 5 years (8% versus 3%) and 10 years (38% versus 10%). On multivariable analysis, HDR-BT remained independently associated with BCF (HR 5.26). No differences in distant metastases, CSS, or OS. PSA nadir and time to nadir were similar, but 4-year PSA response (<0.4 ng/mL) favored SBRT (68% vs 57%). Recognizing toxicity data were available for only one-third of SBRT patients, acute grade 2+ GU events appeared higher with HDR-brachy (75% vs 52%), while late grade 2+ events and quality-of-life domains appeared similar.
TBL: The longest prospective comparison to date indicates ultra-hypofractionated external beam radiation versus stand-alone HDR-brachytherapy for intermediate-risk prostate cancer achieves considerably higher rates of biochemical control at 10 years with comparable late toxicity. | Udovicich, JAMA Netw Open 2026
The Study: In this pooled analysis of individual patient data (n=247) across 5 prospective trials, investigators compared ultra-hypofrac over 2-5 treatments (n=180) versus 2-fraction high-dose-rate (HDR) brachy (n=67) for intermediate-risk prostate cancer receiving no ADT. Median follow-up approached ten years. Despite the ultra-frac cohort harboring more unfavorable features (62% vs 39%), biochemical failure was significantly higher with HDR-brachy at 5 years (8% versus 3%) and 10 years (38% versus 10%). On multivariable analysis, HDR-BT remained independently associated with BCF (HR 5.26). No differences in distant metastases, CSS, or OS. PSA nadir and time to nadir were similar, but 4-year PSA response (<0.4 ng/mL) favored SBRT (68% vs 57%). Recognizing toxicity data were available for only one-third of SBRT patients, acute grade 2+ GU events appeared higher with HDR-brachy (75% vs 52%), while late grade 2+ events and quality-of-life domains appeared similar.
TBL: The longest prospective comparison to date indicates ultra-hypofractionated external beam radiation versus stand-alone HDR-brachytherapy for intermediate-risk prostate cancer achieves considerably higher rates of biochemical control at 10 years with comparable late toxicity. | Udovicich, JAMA Netw Open 2026