{"entity":{"id":"ascende-rt","kind":"trial","name":"ASCENDE-RT","aka":["ASCENDE-RT","Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy"],"tldr":"Adding radioactive seeds inside the prostate on top of external radiotherapy halves the chance that the PSA comes back, but it does not make men live longer and it costs more urinary side effects.","summary":"ASCENDE-RT enrolled 398 men, median age 68, of whom 69 percent had high-risk disease. All received 12 months of androgen deprivation and 46 Gy to the pelvis. They were then randomised to a dose-escalated external beam boost to 78 Gy or to a low-dose-rate prostate brachytherapy boost.\n\nIn the intention-to-treat analysis at a median 6.5 years, men randomised to the external beam boost were twice as likely to have biochemical failure: multivariable hazard ratio 2.04, p=0.004. Kaplan-Meier biochemical progression-free survival at 5, 7 and 9 years was 89, 86 and 83 percent with the brachytherapy boost against 84, 75 and 62 percent with the external beam boost (log-rank p<0.001). The benefit held in both intermediate-risk and high-risk men, and because the curves diverge sharply after 4 years the gap should widen with longer follow-up.\n\nNo overall survival difference was seen: multivariable hazard ratio 1.13, p=0.62. On multivariable analysis only age (hazard ratio 1.06 per year, p=0.004) and biochemical failure itself (6.30, p<0.001) predicted death. The trial therefore proves that a brachytherapy boost controls PSA better and does not prove that it saves lives, which, together with its genitourinary toxicity, is why it is offered as an option rather than as the default.","status":"mixed","asOf":"2026-09-25","links":[{"label":"ClinicalTrials.gov NCT00175396","url":"https://clinicaltrials.gov/study/NCT00175396"},{"label":"ASCENDE-RT survival endpoints (International Journal of Radiation Oncology Biology Physics 2017)","url":"https://doi.org/10.1016/j.ijrobp.2016.11.026"},{"label":"NICE NG131: prostate cancer: diagnosis and management","url":"https://www.nice.org.uk/guidance/ng131"}],"tags":[],"related":[],"cancers":["prostate","prostate-intermediate-risk","prostate-high-risk"],"sections":[],"technologies":["ldr-seed-brachytherapy","brachytherapy","imrt-igrt","androgen-deprivation"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["brachytherapy-term","adt","curative-intent","biochemical-recurrence"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT00175396","phase":"3","setting":"Intermediate-risk and high-risk localised prostate cancer, 69 percent high risk: 12 months of androgen deprivation and 46 Gy pelvic radiotherapy for everyone, then either a dose-escalated external beam boost to 78 Gy or a low-dose-rate prostate brachytherapy boost, with biochemical progression-free survival as the primary endpoint","sponsor":"British Columbia Cancer Agency","result":"Nine-year biochemical progression-free survival 83 percent with a low-dose-rate brachytherapy boost against 62 percent with a dose-escalated external beam boost (multivariable hazard ratio for failure 2.04, p=0.004); no overall survival difference (1.13, p=0.62).","yearReported":2017,"enrolled":398,"enrolledBasis":"randomised","enrolledNote":"398 men were randomised, 200 to the external beam boost and 198 to the brachytherapy boost.","outcomes":[{"endpoint":"Biochemical progression-free survival at 9 years","primary":true,"unit":"%","arms":[{"name":"Low-dose-rate brachytherapy boost","n":198,"value":83},{"name":"Dose-escalated external beam boost to 78 Gy","n":200,"value":62}],"p":"<0.001","source":"https://doi.org/10.1016/j.ijrobp.2016.11.026"},{"endpoint":"Overall survival","arms":[{"name":"Low-dose-rate brachytherapy boost","n":198,"note":"Multivariable hazard ratio; no significant difference."},{"name":"Dose-escalated external beam boost to 78 Gy","n":200}],"hr":1.13,"p":"0.62","source":"https://doi.org/10.1016/j.ijrobp.2016.11.026"}],"replication":"Not replicated in a second randomised trial with a survival endpoint; the brachytherapy boost is recommended as an option in guidelines on the strength of this trial alone."},"route":"/trials/ascende-rt/","neighbours":{"cancer":[{"id":"prostate-high-risk","kind":"cancer","name":"Localised prostate cancer, high and very high risk","route":"/cancers/prostate-high-risk/"},{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"androgen-deprivation","kind":"technology","name":"Androgen deprivation & AR pathway inhibitors","route":"/technologies/androgen-deprivation/"},{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"ldr-seed-brachytherapy","kind":"technology","name":"Low-dose-rate seed brachytherapy","route":"/technologies/ldr-seed-brachytherapy/"}],"term":[{"id":"adt","kind":"term","name":"Androgen deprivation therapy (ADT)","route":"/terms/adt/"},{"id":"biochemical-recurrence","kind":"term","name":"Biochemical recurrence (BCR)","route":"/terms/biochemical-recurrence/"},{"id":"brachytherapy-term","kind":"term","name":"Brachytherapy (internal radiotherapy)","route":"/terms/brachytherapy-term/"},{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"}]}}