For high risk prostate cancer treated with external beam RT, long-course ADT is associated with better treatment outcomes. In the ASCENDE-RT trial, brachytherapy boost for high risk disease improved freedom from biochemical progression. A question that often arises when a brachy boost is used for high risk disease is whether long-term ADT is better than short-term ADT. This phase 3 trial randomized 332 patients with high risk disease to either 6 months ADT or 30 months of ADT along with prostate LDR brachytherapy (110 Gy using I-125) and 45 Gy in 25 fractions to the pelvis. At 7 years, prolonged ADT did not significantly reduce the cumulative incidence of biochemical progression (8% v 9%). We now know that biochemical outcomes are poor surrogates for survival outcomes, but there were also no differences in OS or disease-specific mortality at this time point. | Yorozu, Int J Radiat Oncol Biol Phys 2023
