As you are so fond of saying, the devil is in the details. No, it is not a reasonable assessment because there was nothing to which it was being compared. That is why doctors do randomized clinical trials - to find out what would have happened to a closely matched sample had they not given them the therapy in question.
Secondly, this wasn't even a clinical trial at all. It was a retrospective database analysis. We have no idea why patients were selected for the therapy they received, and there isn't even a case matching for comparison. This is Level 3 evidence that you're trying to compare to Level 1 evidence.
Third, the median follow-up here was 50 months and only 4-yr oncological results were reported. While this is way too short, it is even less useful because almost all the patients (86%) had at least 2 years of ADT. The ADT alone may explain why there were just 30 biochemical recurrences in 4 years. Bone scan/CT was used to detect distant recurrences. In 25/30 biochemical failures, a distant site was identified, and no further searches were done for local failures that may have metastasized to those distant sites.
Now contrast this with ASCENDE-RT:
• It was
a large prospective randomized clinical trial (Level 1 evidence) comparing brachy boost to EBRT-only
• 9-year oncological results were reported
• Only 1 year of ADT was used
• The EBRT-only dose was similar (78 Gy/39 fx)
• Notably, even with 9 years of follow-up and only 1 year of ADT, metastases, prostate cancer-specific mortality, and overall mortality were rare events
• Among those with high-risk prostate cancer, 9-year bPFS was 83% for the brachy boost cohort vs. 62% for EBRT-only.Brachy Boost: The gold standard for progression-free survival of high risk prostate cancer
It was a day-and-night difference in the quality of those studies.
If I sounded bewildered that you would put forward this database analysis as any kind of proof, it's only because you professed to understand these kinds of details. You had said previously that the reason for your decision was based on toxicity, not oncological outcomes, which you had agreed was better with the brachy boost. A lot of people don't understand the ins-and-outs of research studies, and that is certainly OK - I wouldn't expect most of them to. But I thought you did because you sounded so assured. Now that I realize that about
you, I will endeavor to be more patient. I apologize for misunderstanding the source of your error.