Long-term survival does not differ markedly among patients with intermediate-risk prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT), dose-escalated external beam radiation therapy (DE-EBRT), or brachytherapy (BT), according to new study findings.

Using the National Cancer Database (NCDB) 2004 to 2014, investigators identified 30,766 men (median age 69 years) diagnosed with intermediate-risk PCa (Gleason score of 6-7, clinical stage T1-T2, and PSA less than 20 ng/mL) who were treated with radiation therapy (RT). Of these, 12,864 patients (41.8%) received BT, 17,247 patients (56.1%) DE-EBRT, and 655 patients (2.1%) SBRT.

From 2004 to 2014, SBRT use and DE-EBRT use steadily increased from 0.03% to 10.6% and from 48.3% to 62.0%, respectively, but BT use decreased from 48.3% to 27.4%.

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Among the 24,953 men with favorable-intermediate risk disease (81.1% of cohort), the study found no significant differences in 10-year overall survival between those treated with BT vs SBRT or SBRT vs DE-EBRT, Albert J. Chang, MD, PhD, Department of Radiation Oncology, University of California, Los Angeles (UCLA), and colleagues reported in JAMA Network Open. Overall survival also did not differ between these RT modalities in the group of 5813 men with unfavorable-intermediate risk disease (18.9% of cohort).

BT was associated with a slight survival advantage over DE-EBRT, however, in both the favorable- and unfavorable-intermediate risk groups, according to Dr Chang’s team. Ten-year overall survival favored BT: 69.8% vs 66.1% in the favorable-risk group and 61.2% vs 58.7% in the unfavorable-risk group, respectively. The risk for all-cause mortality was a significant 12% and 18% lower among men with favorable- and unfavorable-risk disease, respectively, treated with BT vs DE-EBRT (both P <.001).

“As radiation modalities trend toward hypofractionation with major considerations toward cost-effective treatment, our preliminary evaluation suggests that SBRT and BT remain appropriate management strategies in delivering value-based care,” Dr Chang and colleagues stated.

Due to limitations of the NCDB, the researchers could not compare toxicity, biochemical recurrence, distant recurrence, and cancer-specific survival among RT modalities.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Nguyen KA, Lee A, Patel SA, et al. Trends in use and comparison of stereotactic body radiation therapy, brachytherapy, and dose-escalated external beam radiation therapy for the management of localized, intermediate-risk prostate cancer. JAMA Netw Open. Published online September 24, 2020. doi:10.1001/jamanetworkopen.2020.17144