Phase 2 BALANCE-RT compares HDR brachytherapy boost vs SBRT alone (radiation intensification).

Memorial Sloan Kettering Cancer Center is running BALANCE-RT (NCT07751159) to test whether adding an HDR brachytherapy boost (temporary internal radiation that delivers very high dose inside the prostate) to SBRT (high-precision external beam radiation delivered in a few treatments) improves cancer control without meaningfully worsening urinary, bowel, or sexual side effects. The design is a randomized, two-arm comparison: Arm A receives HDR brachytherapy boost plus SBRT, while Arm B receives SBRT alone. The eligible population is non-metastatic prostate cancer with unfavorable intermediate-, high-, or very high-risk features, where the key clinical tradeoff is tighter local control versus higher risk of GU/GI toxicity from dose escalation. A practical angle is that SBRT-alone regimens are increasingly used for convenience and access, while brachytherapy boosts can improve dose intensification but require specialized expertise and an invasive procedure. Today’s typical curative-intent care for these higher-risk groups is radiation plus androgen-deprivation therapy (often longer-course for higher-risk disease), with some centers adding a brachytherapy boost for further intensification.