EURURO Vol. 72 No. 5

746 860

p = 0.004). At 7 yr, the OS by treatment arm is 85.7% versus
81.5%, a similar magnitude of difference in favor, once again,
of the use of an LDR brachytherapy boost.
Disturbingly, Johnson et al report that the use of LDR
prostate brachytherapy as a boost is declining in the USA,
from29% in 2004 to 14% in 2012. There are many reasons for
this, including more favorable reimbursement in the USA
for other forms of radiotherapy such as intensity-modulat-
ed radiation therapy, the fact that declining use of a
modality is self-perpetuating in that there are fewer and
fewer training opportunities, concerns about liability for
treatment-related toxicity, and increasing use of robotic
prostatectomy. The results of Ascende-RT were first
presented in 2015 and published in 2017. Dissemination
of these results is expected to create renewed interest in
brachytherapy. To meet these demands, the American
Society of Therapeutic Radiation and Oncology has offered a
Prostate Brachytherapy Simulation Workshop for the past
2 yr as part of the Annual Meeting, and the American
Brachytherapy Society now offers a Brachytherapy Simula-
tion Workshop in addition to the Brachytherapy Schools. If
the addition of a brachytherapy boost is indeed indispens-
able in the optimal management of unfavorable prostate
cancer, meeting the training demands of a nation so that
optimal treatment can be offered to all who require it will
be a major challenge.
Much fanfare in recent years has focused on the harms of
screening, resulting in overdiagnosis and overtreatment of
nonlethal prostate cancer, such that policy-makers appear
to have lost sight of the real threat of unfavorable prostate
cancer, a potentially lethal disease. Optimal treatment of
these men, to prevent the otherwise inevitable progression
to castrate-resistant disease and the ensuing cascade of
extremely costly palliative interventions, is of paramount
concern.
Conflicts of interest: Research funding from Ferring Pharmaceuticals.
Advisory Board member for Varian Medical Systems. Scientific Advisor
for Concure Breast Microseed. Speaker Honorarium from Abbott. Former
President of the American Brachytherapy Society.
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