Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A Single-Institution Matched-Pair Analysis

Brachytherapy Improves Biochemical Failure–Free Survival in Low- and Intermediate-Risk Prostate Cancer Compared With Conventionally Fractionated External Beam Radiation Therapy: A Propensity Score Matched Analysis

“…1A). In a separate, Canadian matched-pair study, Pickles et al (23) reported superior bFFS in patients treated with LDR-BT compared with (Fig. 1E).…”

“…The rapid adoption of new RT practices as well as patient preference toward more convenient BT treatments are proposed explanations for the lack of comparative RT trials (13). A large number of retrospective studies have attempted to compare the treatment effectiveness of 2 or more RT modalities (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). However, interpretation of this retrospective evidence can be challenging because very few studies make direct comparisons in homogenous GUROC low-or intermediate-risk patient populations.…”

Be it resolved that in the modern era, the best method for dose escalation is brachytherapy: The con position

“…20 It is not surprising that LDR brachytherapy (which provides a biologically effective dose of 101 Gy) improves the sevenyear biochemical disease-free survival (bDFS) compared to 68 Gy (94% vs. 74%, p < 0.001) 21 and 81 Gy (94% vs. 89%, p = 0.004) 22 of EBRT (conventionally fractionated). The safe dose limit for standard EBRT is 86 Gy, whereas with hypofractionated accelerated image-guided radiation (called stereotactic body radiation, SBRT), biologically effective doses up to 168 Gy 1.4 are achievable safely.…”

Chapter 4

“…5 While there are very few studies comparing the side effects of EBRT and PB, EBRT is generally associated with substantially fewer urinary side effects, but greater rectal toxicity. 39 External beam radiation therapy is commonly delivered over a period of 7 to 8 weeks of daily treatments. Combination of EBRT and brachytherapy is considered to be more effective than EBRT alone in some intermediate-risk patients and in high-risk patients.…”

“…Seven-year PRFS rates were 95% for PB and 75% for EBRT. 39 Unlike brachytherapy, patients treated with EBRT continue to experience more PSA failures with longer follow-up. Active surveillance.…”