High risks.

Another large undertaking to understand outcomes for recurrent disease following definitive radiation for high risk prostate suggests this is a no bueno scenario. Across nearly 1K such cases, rates of distant mets and prostate cancer-specific mortality were 50% and 29%, respectively, after external beam alone (n=654) and 34% and 27% after external beam + brachytherapy (n=324). What’s more, shorter disease-free intervals were associated with higher prostate cancer-specific mortality in a continuous fashion. Ultimately, the biggest gains to be seen in this arena is optimizing patient selection for upfront local therapy with advanced imaging. | Philipson, Eur Urol 2021