The ASCENDE-RT trial found that pelvic external beam radiation (EBRT) to 46 Gy in 23 fractions with a low dose rate (LDR) brachytherapy boost to 115 Gy using I125 improves biochemical control compared to pelvic EBRT with dose-escalated prostate EBRT to a total of 78 Gy in 39 fractions in men with intermediate and high risk prostate cancer. But does that translate to improved long-term survival outcomes? In this report, freedom from biochemical progression at 10 years remains significantly higher with a brachy boost (85% v 67%). Interestingly, that did not translate into a significant improvement in freedom from distant metastasis (88% v 86%) or overall survival (80% v 75%) at 10 years. The rate of prostate cancer mortality at 10 years was 6% after brachy compared to 9% after EBRT boost.
- Oh, Int J Radiat Oncol Biol Phys 2022