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Has the recent SBRT vs HDR monotherapy analysis changed your use of HDR monotherapy for intermediate-risk prostate cancer?

In light of the recent pooled prospective analysis by Udovicich et al., PMID 41739470 comparing SBRT and HDR brachytherapy monotherapy for intermediate-risk prostate cancer, which reported superior long-term biochemical control with SBRT compared with HDR monotherapy (13.5 Gy × 2), has this changed your practice regarding HDR monotherapy? Do you continue to offer HDR monotherapy using 13.5 Gy × 2, have you modified your dose/fractionation regimen, or are you increasingly favoring SBRT outside of a clinical trial? How do you interpret these findings in the context of the existing prospective HDR literature and the limitations of a non-randomized comparison?
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Radiation Oncology · Varian Medical Systems/Allegheny health network
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With excellent outcomes with SBRT in this group (PACE-B), the additional advantage of brachy is limited. The predominant use of HDR brachy is either as a boost for high-risk or as salvage after previous EBRT.

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Radiation Oncology
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My short answer is that I continue to consider both SBRT and HDR as acceptable standards of care for localized, intermediate-risk prostate cancer. Although this study does present a provocative conclusion, I ultimately ran into some trouble understanding the methodology easily from the paper, which ...

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Radiation Oncology · Virginia Commonwealth University Medical Center
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Unfortunately, there will probably never be a head-to-head randomized comparison of SBRT vs HDR monotherapy, given the non-invasive nature of the former vs the latter, so we are left with post-hoc comparisons of prospective trials of the 2 modalities separately and retrospective data. The Udovicich ...

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