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Top Line: It can sometimes feel like that’s a more apt term for intermediate risk prostate cancer.
The Study: In 2013, intermediate risk prostate cancer was subdivided into two groups (i.e. favorable and unfavorable) based on outcomes after dose-escalated external beam radiation according to predominant Gleason score, PSA, and volume of disease. Does this hold true in the era of brachytherapy re-emergence? This is a large single institution retrospective look at outcomes after prostate brachy monotherapy among over 1500 men spanning the gamut of intermediate risk prostate cancer (half favorable, half unfavorable). All brachy consisted of I-125 low dose rate (LDR) interstitial technique to a dose of 144 Gy +/- androgen deprivation therapy (ADT). As expected, at a median follow-up of 4 years, those with unfavorable risk disease had higher rates of biochemical failure (17% versus 4%) and distant mets (<2% versus >5%). Perhaps most interesting is yet more findings of no impact of ADT when given in conjunction with brachytherapy. In fact, at least in this series, outcomes with ADT were considerably worse.
TBL: Traditionally-defined unfavorable intermediate risk prostate cancer has worse outcomes than their favorable counterparts after brachy monotherapy, and none of them seem to benefit from the addition of ADT. | Tom, Brachytherapy 2020