For patients with clinically node-positive prostate cancer, would you consider adding a brachytherapy boost to external beam radiation and ADT?
Absolutely not. Unless on a clinical trial.
Not only are these patients excluded from every brachy trial, there is essentially zero retrospective data. Thus you have essentially no data that this will help the patient. However, what you know is that it will increase cost and increase toxicity.
We've had discussions about such patients (prostate in place and with cN+ disease) at our center. Can we extrapolate from ASCENDE-RT to patients with node positive disease and suggest a benefit to adding brachytherapy? In the absence of great trials, I tend to agree with @Dr. First Last that we can'...
Though not eligible for ASCENDE-RT and brachy boost not listed currently as option for clinically node+ prostate cancer, I do consider brachy boost in this situation.
As the volume of data demonstrating impact of loco-regional treatment in both the node+ and even metastatic setting grows, it does ma...
Bear in mind, it becomes difficult to criticize our urologic colleagues’ recommendations for prostatectomy in locally advanced, node positive or (even) M1 disease when we, ourselves, begin advocating for more aggressive (and potentially more toxic) local therapy in the absent of data.
I have been reluctant to do brachy boost as absolute benefit additional local control in these pts would be small because of high and competing risk of distant Mets and need to consider increased morbidity with the procedure into equation also. If we extend brachy boost to node positive then with st...
There may be some merit to the argument of brachy in N1 pts. If we are going to treat the primary site for M1 pts, obviously there is benefit to control primary site. Brachy is most effective in local control, especially in high grade disease.
I will admit that I have not done brachy in N1 pts, but ...