Prostate Cancer Coverage from Every Angle

Comparison of Outcomes With Various Treatments of Localized Prostate Cancer

By: Melissa Steele-Ogus
Posted: Monday, January 4, 2021

A retrospective study published in JAMA Network Open compared outcomes in patients with localized, intermediate-risk prostate cancer who received three different treatments: stereotactic body radiation therapy (SBRT), brachytherapy, and dose-escalated external-beam radiotherapy (EBRT). Albert J. Chang, MD, PhD, of the David Geffen School of Medicine, University of California, Los Angeles, and collaborators found no difference in long-term survival between patients treated with any of these three options.

Researchers used the National Cancer Database to identify patients with intermediate-risk, localized prostate cancer diagnosed between January 2004 and December 2014. Patients had received SBRT, brachytherapy, or dose-escalated EBRT. A total of 30,766 men were eligible, 24,953 (81.1%) of whom had favorable, intermediate-risk disease, and 5,813 (18.9%) of whom had unfavorable intermediate-risk disease. The median participant age was 69 years, and the median follow-up was 6.7 years. Brachytherapy was used in 12,864 patients (41.8%); dose-escalated EBRT, in 17,247 patients (56.1%); and SBRT, in 655 patients (2.1%).

When compared pairwise in the favorable intermediate-risk cohort, there was no significant difference in 10-year overall survival between brachytherapy and SBRT (67.02% vs. 64.2%, P = .16) or SBRT and dose-escalated EBRT (64.2% vs. 70.9%, P = .55). There was a small but significant difference in 10-year overall survival in patients receiving brachytherapy compared with those receiving dose-escalated EBRT (69.8% vs. 66.1%, P < .001). The unfavorable-risk cohort had similar results, with 10-year overall survival rates with brachytherapy and SBRT of 64.9% and 63.2%, respectively (P = .33), and 63.2% with SBRT versus 66.6% with dose-escalated EBRT (P = .32). Those who received brachytherapy also had better overall survival (61.2%) than those who were given dose-escalated EBRT (58.7%, P < .001).

“As radiation modalities trend toward hypofractionation with major considerations toward cost-effective treatment, our preliminary evaluation suggests that SBRT and brachytherapy remain appropriate management strategies in delivering value-based care,” the authors noted.

Disclosure: For full author disclosures, visit

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