Chose SBRT over brachytherapy, but is long term survival the same?

[Nerka]

I have pretty much decided to do SBRT. I had SpaceOAR last week and I have the pre-radiation appointment this Tuesday. Then approximately two weeks later radiation starts. I am second guessing myself now as my brother also has Prostate Cancer, and his doctors telling him that Brachytherapy (In his case LDR) has a better long term survival rate. For those people who have undergone radiation therapy, what did your doctors tell you about long term survivability? The radiation machine they will use on me is the MRI-Guided Linac "MRIdian", which is very modern (They got it 5 months ago), and so I assume that the results would be as good as SBRT can be. Tall Allen, this question might be up your alley...

[Tall_Allen]

I can't answer because you didn't provide enough info. You didn't fill in your profile. Do you have GS 3+4 or GS 4+3? What was your last PSA? Stage? What are your brother's diagnostic info? Are they planning on giving him LDR brachy monotherapy or brachy boost therapy (brachy + external beam radiation + ADT)?

[Nerka in reply to Tall_Allen]

Allen,

I have Gleason 3+4=7, 3 cores out of 12 were positive, Last PSA=10 (4 months ago), Negative on rectal exam, MRI RADS4 (1 x 1cm) and RADS5 (1x2cm) on a 32 ml prostate.

In my brothers case he has more positive cores 5/12, 3+4=7, No MRI yet (Why I do not know or he hasn't told me). PSA somewhere near 5 or 6. I will ask him to confirm. Doctors are saying LDR as monotherapy OVERALL is better then SBRT for a "cure rate". Seems to imply that it would work better in his case.

[Tall_Allen in reply to Nerka]

His doctors are not correct. SBRT has never been compared directly to brachytherapy, so they cannot know that. You both have favorable intermediate risk prostate cancer. In non-comparative trials, your type of prostate cancer had:

• SBRT: 7-year biochemical recurrence-free survival (bRFS) of 91.4%

• LDR brachytherapy: 5-year bRFS of 91.9%, and 10-year bRFS of 81.5% (so 7-year bRFS would be somewhere in between (roughly 87%)

So, I would say they are very comparable.

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