For what it's worth.

Top Line: Does the addition of brachytherapy to external beam radiation for prostate cancer actually improve survival?
The Study: The NCDB analysis de jour is a survival analysis of men with high risk prostate cancer treated with either [1] prostatectomy (RP), [2] external beam radiation (RT) and androgen deprivation (ADT), or [3] RT and brachy (RT+BT) +/- ADT. Remember the ASCENDE-RT trial demonstrated improved biochemical recurrence-free survival (bRFS) with the addition of brachy to RT, but there weren’t enough survival events to comment on mortality. Why include the RP group? Because you can’t republish the same exact study that was just published last year. Let’s quickly run the numbers: of >80K cases that met inclusion criteria, only half were analyzed. And only 6% of these were treated with RT+BT. After significant statistical massaging, the authors found that overall mortality was higher with RT compared to either RP or RT+BT. This is supported by the bRFS rates that… oh yeah, the NCDB doesn’t collect disease outcomes. So why wasn't the sizeable bRFS benefit (of 20% at 9 years) in ASCENDE-RT reflected in mortality outcomes here? Perhaps because only 5% of patients died of prostate cancer, meaning most mortality was attributable to something else. Chances are that “something else” may play a big part in determining if someone is healthy enough to undergo a procedure under anesthesia.
Bottom Line: Overall mortality is the same for men with high risk prostate cancer treated with either RP or RT+BT but worse with RT without BT, at least according to NCDB data for whatever that’s worth...which may not be much. | Ennis, J Clin Oncol 2018


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