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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.
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.
In 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.
No 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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
398 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Biochemical progression-free survival at 9 yearsprimary | Low-dose-rate brachytherapy boost | 198 | 83% | - | <0.001 | link |
| Dose-escalated external beam boost to 78 Gy | 200 | 62% | ||||
| Overall survival | Low-dose-rate brachytherapy boost | 198 | Multivariable hazard ratio; no significant difference. | 1.13 | 0.62 | link |
| Dose-escalated external beam boost to 78 Gy | 200 | - |
Shares Biochemical recurrence (BCR), Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, intermediate risk.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, intermediate risk, Androgen deprivation & AR pathway inhibitors.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares Curative intent vs palliative intent, Androgen deprivation therapy (ADT), Localised prostate cancer, high and very high risk, Androgen deprivation & AR pathway inhibitors.
Shares Biochemical recurrence (BCR), Androgen deprivation therapy (ADT), Androgen deprivation & AR pathway inhibitors, IMRT / IGRT (modern external beam).