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This time we’re talking about an unexpected upside to prostate brachytherapy. We know its use as a boost after external beam radiation slashes biochemical recurrence rates for high-risk prostate cancers, at least when used with one year of androgen-deprivation therapy (ADT). But perhaps a brachy boost can buy more than a delay in PSA. A thought-provoking NCDB analysis reported this week suggests that high-risk prostate cancer patients receiving a brachy boost may be able to avoid ADT all together. Among nearly 50K high-risk patients analyzed, there was a significant (statistically, not clinically, speaking...looking at you Figure 2) improvement in overall survival when ADT was added to dose-escalated external beam radiation, as expected. But no improvement when ADT was added to a brachy boost. Furthermore, interaction tests consistently showed ADT’s effect on prolonging survival was significantly curbed if delivered in conjunction with brachytherapy. Practice-changing? Probably not. Interesting idea for a future clinical trial? We think so, especially if someone else is paying.