A brachy brawl.

Top Line: In case you missed it, ASCO released 2017 guidelines stating that a brachytherapy boost should be offered to all men receiving definitive radiation for unfavorable-intermediate to high risk prostate cancer.

Guideline: As you might imagine, this ruffled a few feathers, particularly among practices who don’t standardly offer prostate brachy procedures. One more circulated editorial compared the data supporting a survival benefit with a brachy boost to those purporting a benefit with radical prostatectomy; in other words, retrospective studies are always going to come with tremendous confounders. And when it comes to the three randomized trials on the subject, they make a pretty compelling argument that biochemical control alone simply isn’t a meaningful endpoint—after all, if it were, all men with low risk disease would be getting ADT (we see you RTOG 94-08). Now, in a move to put itself on the map once and for all, the American Brachytherapy Society (ABS) has endorsed the 2017 ASCO guidelines calling for all men with unfavorable-intermediate and higher risk disease to be offered a brachy boost. Go figure. They primarily harp on the drastic overstating of side effects with brachy when referencing rates of transient rather than lingering toxicity. In any case, these statements are all worth your read if for no other reason than to see the ABS use the brachy dissenters’ own previous quotes against them. Oh no they dint.

Bottom Line: Pick a side, because clear camps are forming on whether all men with higher risk prostate cancer should be offered brachytherapy as a component of definitive radiation. And claws are coming out. | Chang, J Clin Oncol 2018