It takes (point) two.

Top Line: Brachytherapy has strikingly different radiobiologic effects on prostate cells than external beam photons, so maybe it deserves a different prostate-specific antigen (PSA) threshold for biochemical failure.
The Study: After all, urologists and rad oncs use two very different thresholds following their respective definitive therapies: an absolute value of 0.2 ng/mL in the first case and 2.0 ng/mL above nadir in the second. While there’s good reason for this—namely that external beam radiation leaves behind normal PSA-producing cells and surgery shouldn’t—the differing rules add another dimension of complexity in any attempt to compare biochemical control across treatment modalities. So in which category should brachy fall? Enter this reanalysis of the ASCENDE-RT trial in which patients with intermediate and high risk prostate cancer were randomized to dose-escalated prostate radiation with external beam versus brachy. As expected, re-defining failure from ≥2.0+nadir → >0.2 ng/ml murdered biochemical control rates at 9 years in the external beam arm from 63 → 31%. Shockingly, though, rates in the brachy arm were virtually indistinguishable at 85 → 82%. Wow.
Bottom Line: These authors, albeit in the “Brachytherapy” journal, suggest biochemical control of prostate cancer following brachy versus surgery can now be better compared, with brachy clearly reigning victorious. | Morris, Brachytherapy 2018

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  1. I am cool with the page and fine with it being an open page. I only bring it up because there was recently a thread on the page discussing the open nature of the page. During that thread it was pointed out that the church opted not to operate a facebook page and so several congregants began and administer the page. There seemed to be a lot of folks who were surprised or had forgotten that the page was unofficial.
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