Very high ascent.

The ASCENDE-RT trial showed that dose-escalated prostate radiation using a brachytherapy boost after pelvic radiation reduces the risk of biochemical recurrence compared to dose-escalated external beam radiation (EBRT) alone. But does brachy boost improve distant mets or survival outcomes among those with very high risk disease? This study compared outcomes after EBRT alone or EBRT + brachy boost in a large, multicenter cohort of men with very high risk prostate cancer based on both the NCCN (n=371) and STAMPEDE (n=220) criteria. Most were treated with EBRT alone (72.8%) to a median total dose of 79.8Gy EQD2 and a median 26.4 months of ADT. Median ADT duration with EBRT+BT was 24 months. There was no difference in the rate of 8-year prostate cancer specific mortality with EBRT alone compared to EBRT+BT (7.6% v 11.9%). Nor was there a difference in DM (18.3% v 14.8%). There were also no differences in PCSM (8% v 17.6%) or DM (22.3% v 14.9%) among those with STAMPEDE-defined very high risk disease. | Patel, Int J Radiat Oncol Biol Phys 2022