For men with intermediate or high-risk prostate cancer, can an SBRT boost be used in place of a brachytherapy boost after EBRT?

I would respectfully disagree with @Dr. First Last and @Dr. First Last on this subject. Probably because the issue is much more complicated than they elude.

One thing that is not complicated is that dose is dose. Or rather effective dose is effective dose. So any method of accurately delivering that dose will be equivalent.

A frequently noted "benefit" of brachytherapy is heterogeneity. Speculation regarding heterogeneity of brachtherapy as advantage (while we seek to limit it dosimetrically in al...

I would not use an SBRT boost for intermediate or high risk prostate cancer. Although the radiobiology of an SBRT boost and brachytherapy boost are similar, there is minimal data looking at the efficacy and toxicity of combining IMRT and an SBRT boost. This is in contrast to the brachytherapy boost experience where there is extensive experience and data, including most recently the results of the ASCENDE trial.

A few centers have published promising early results for utilizing SBRT as a boost (UCSF, Georgetown, Flushing, Chi Mei Medical Center, Inha University Hospital), with perhaps a total of <300 patients reported on total. Efficacy and toxicity results appear to compare favorably with series of dose-escalated IMRT or IMRT with a brachytherapy boost. For example, the Georgetown group recently published favorable outcomes with a median followup of ~4 years (https://www.ncbi.nlm.nih.gov/pubmed/2822411...