Dr. Nguyen on the Utility of a Brachytherapy Boost in the ASCENDE-RT Trial

Paul L. Nguyen, MD, senior physician and director ofGenitourinary Clinical Center for Radiation Oncology at Dana-Farber Cancer Institute, as well as a professor of radiation oncology at Harvard Medical School, discusses the utility of adding a brachytherapy boost to radiation therapy in the ASCENDE-RT trial.

In the ASCENDE-RT trial, investigators examined patients with unfavorable intermediate- or high-risk prostate cancer and found that the addition of a brachytherapy boost to standard radiation reduced the risk of disease recurrence by half, says Nguyen. Moreover, after 9 years, the rate of biochemical recurrence-free survival (RFS) improved from 63% to 83%.

For high-risk patients, the rate of biochemical RFS was also improved, going from 58% to 78%. These data highlight that it is important to offer the brachytherapy boost, especially for high-risk patients, stresses Nguyen.

Thus far, improvements in metastasis-free survival or overall survival have not yet been observed. More adverse effects have been observed with the regimen, meaning patients must be selected carefully. For most young and healthy patients, this therapy should be offered in order to maximize the chance of cure, minimize the psychological distress of potential recurrence, and minimize the chance of going on lifelong androgen deprivation therapy after recurrence, concludes Nguyen.