{"doi":"10.1016/j.brachy.2025.09.006","title":"Impact of locoregional treatment intensification in stampede high-risk M0 prostate cancer patients","abstract":"INTRODUCTION: This study evaluates the efficacy of locoregional treatment intensification with combined modality therapy (CMT) for STAMPEDE high-risk (SHR) nonmetastatic (M0) prostate cancer. We compare metastasis-free survival (MFS) and overall survival (OS) between external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT), CMT with a brachytherapy boost, and up-front surgery. MATERIAL AND METHODS: A retrospective cohort of 217 SHR patients from our institutional database was stratified by treatment modality: EBRT + ADT (n = 56), CMT (n = 61), and surgery (n = 100). Median ADT duration was 24 months for the EBRT + ADT group and 6 months for the CMT group. Primary outcomes were MFS and OS, analyzed using Cox proportional hazards regression and Fine-Gray competing risks models, adjusted for PSA, age, and Gleason group. RESULTS: CMT significantly improved adjusted MFS compared to EBRT + ADT (HR 0.41; p = 0.004). In contrast, up-front surgery did not significantly improve MFS over EBRT + ADT (HR 0.84; p = 0.471). Adjusted OS was also superior with CMT compared to EBRT + ADT (HR 1.98; p = 0.025). On subgroup analysis, the MFS benefit of CMT persisted for N0 patients but not for N1 patients. A key limitation is the retrospective, nonrandomized nature of the data. DISCUSSION AND CONCLUSIONS: Locoregional treatment intensification with CMT and de-intensified ADT offers significant oncologic benefits in men with SHR M0 prostate cancer, particularly in N0 patients. These findings support further investigation into combining brachytherapy and systemic therapy with de-intensified ADT in prospective trials.","journal":"Brachytherapy","year":2025,"id":577974,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9306,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":541105,"name":"Jonathan D. Tward","orcid":"0000-0001-7765-4473","position":1,"is_corresponding":false},{"id":1487693,"name":"J S Howell","orcid":null,"position":0,"is_corresponding":true}],"reference_count":22,"raw_metadata":null,"created_at":"2026-07-19T02:58:16.148027Z","pmid":"41093695","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}