I disagree and think it will remain regional. As a urologist i'm pretty unimpressed by outcomes in my SBRT patients, both symptomatically and oncologically. Conversely I'm in a spot with an extremely high volume brachy program and the outcomes are excellent. Docs here, both radonc, urologists, and referrings, are all on board and believers in brachy given our outcomes. Likewise reimbursement is highly dependent on the volume of your program. Doing the occasional brachy that takes 90 minutes isn't great. doing 12 in a day that take 15 min a pop in a low cost ASC makes beaucoup bucks on the facility side.
This is coming from someone who came in as a major brachy skeptic. Where I trained, brachy was slow, laborious, and had unimpressive outcomes. Hence the regional effect.
Also will depend heavily on reimbursement incentives moving forward. Many healthcare systems are moving towards risk-sharing/capitated payment models. Tough to beat brachy cost-effectiveness in that setting.