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The 2025 American Society for Radiation Oncology (ASTRO) Annual Meeting |
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| Second Pelvic Malignancies in Localized Prostate Cancer Treated with Radiotherapy: Long-Term Data from Two Phase III Trials |
| Abdenour Nabid, MD |
| Abdenour Nabid presented long-term data from two phase III trials showing that second pelvic malignancies occurred in 3.6% of localized prostate cancer patients treated with radiotherapy, primarily bladder and rectal cancers, with a median onset of 7.5 years after treatment. Rates were slightly higher in high-risk patients and those receiving larger radiation fields, though differences were not statistically significant. |
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| Optimizing Radiation Therapy for Prostate Cancer: Can Dose Reduction to the Pudendal Arteries Preserve Sexual Health? |
| Sophia Kim-Wang, MD, PhD |
| Sophia Kim-Wang presented data suggesting that reducing radiation dose to the internal pudendal arteries may help preserve sexual health in men treated for prostate cancer. In a cohort of 170 men, higher pudendal artery doses correlated with larger declines in sexual function, particularly in those with good baseline function and no ADT. These findings support considering pudendal artery dose constraints in radiation planning to optimize long-term quality of life. |
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| EPIC-26 Longitudinal Analyses of Prostatic Urethral Lift Implant with Stereotactic Ablative Body Radiotherapy for Men with Prostate Cancer and BPH |
| Young Suk Kwon, MD |
| Young Suk Kwon presented results from a phase I trial evaluating prostatic urethral lift followed by stereotactic ablative body radiotherapy in men with prostate cancer and BPH-related urinary symptoms. The study of 15 patients showed the approach was safe, with no grade 3 events, and significantly improved lower urinary tract symptoms at 3 months, while bowel, sexual, and incontinence outcomes remained stable. |
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| Dosimetric Analysis of Post-Radiotherapy Sexual Dysfunction in Patients Receiving Definitive Stereotactic Body Radiotherapy for Prostate Cancer: A Secondary Analysis of MIRAGE |
| Jonathan Massachi, MD |
| Jonathan Massachi presented a secondary analysis of the MIRAGE trial evaluating predictors of sexual dysfunction after stereotactic body radiotherapy (SBRT) for prostate cancer. While MRI-guided SBRT delivered lower doses to neurovascular bundles compared to CT-guided treatment, nearly one-third of men still experienced significant declines in sexual function at 2 years, with no clear dosimetric thresholds identified. |
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| Driving Improvement in Prostate Cancer Radiotherapy Outcomes through a National Quality Assurance Program: Results from a Large UK Academic Center |
| Vishal Manik, FRCR |
| Vishal Manik presented results from a UK academic center showing how participation in the National Prostate Cancer Audit drove improvements in radiotherapy outcomes. After identifying higher-than-average rectal toxicity rates, a multidisciplinary review led to tighter rectal constraints, peer review, enema use, refined image verification, and reduced margins. Following these changes, the 2-year grade ≥2 rectal toxicity rate dropped from 16% to 7.5%, underscoring the value of national quality assurance programs in improving patient outcomes. |
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| Acute Toxicity Following Dose-Escalated MRI-Guided SBRT versus Adapted Dose-Painted MRI-Guided SBRT: A Pooled Comparison of Prospective Trials |
| Travis Courtney, MD, MAS |
| Travis Courtney compared acute toxicity outcomes between dose-escalated MRI-guided SBRT (MIRAGE trial) and adaptive, dose-painted MRI-guided SBRT (HEATWAVE trial). Patients in HEATWAVE experienced significantly higher rates of physician-scored acute GU and GI toxicities, though patient-reported bowel and urinary outcomes were similar between groups. |
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| Intermittent ADT + Comprehensive Stereotactic Body Radiotherapy for Hormone- Sensitive Oligometastatic Prostate Cancer (CROP): Mature Results of a Prospective Trial
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| Patrick Cheung, MD
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| The phase I/II CROP trial evaluated intermittent ADT combined with comprehensive SBRT for hormone-sensitive oligometastatic prostate cancer. With over 6 years of follow-up, the regimen showed low rates of grade 3+ toxicity, favorable PSA responses, and prolonged time to ADT restart, with many patients maintaining intermittent ADT and some remaining progression-free.
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| Local Therapy and Outcome in De Novo Metastatic Prostate Cancer: Individual Patient Data Analysis of the TITAN and ARASENS Trials
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| Soumyajit Roy, MBBS, MSc
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| An individual patient data analysis of the TITAN and ARASENS trials found that local therapy (radiotherapy or prostatectomy) was associated with improved overall survival in men with de novo metastatic prostate cancer, regardless of whether they received ADT alone or ADT + an androgen receptor pathway inhibitor. Radiotherapy, in particular, was linked to significantly better survival, while prostatectomy showed a non-significant trend.
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| The Role of Stereotactic Body Radiotherapy in Oligoprogressive Prostate Cancer: A Site-Specific Analysis of the Prospective, Phase II RADIANT Trial |
| Kara Ruicci, MD, PhD |
| The phase II RADIANT trial found that stereotactic body radiotherapy (SBRT) is a safe and effective option for patients with oligoprogressive prostate cancer, delaying the need for next-line systemic therapy by a median of 13.4 months while maintaining quality of life and showing no grade 3+ toxicities. Local control rates were high, though distant progression remained common, with most failures due to either new lesions or growth of untreated metastases. |
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| Efficacy of All-Site Radiotherapy at the Hormone-Sensitive Stage in Combination with Systemic Therapy in Gleason Grade Group 5 Metastatic Prostate Cancer: Long-Term Data from a Single-Institution
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| Huizhu Chen, MD
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| Huizhu Chen presented long-term data showing that all-site radiotherapy at the hormone-sensitive stage, combined with systemic therapy, significantly improved castration-resistant prostate cancer–free survival in patients with Gleason grade group 5 metastatic prostate cancer. Both low- and high-volume patients benefited, with notable improvements in PSA progression-free survival.
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| Efficacy and Safety of All-Site Radiation Therapy and Standard of Care Therapy With or Without Docetaxel for Hormone-Sensitive High Gleason Score Prostate Cancer: 6-Year Results from a Long-Term Study
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| Huizhu Chen, MD
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| Huizhu Chen reported that in patients with hormone-sensitive, high Gleason score metastatic prostate cancer, combining all-site radiation therapy with standard of care therapy plus docetaxel significantly improved 5-year radiographic progression-free survival compared to standard of care plus all-site radiation alone. The benefit was particularly notable in patients with high tumor burden or synchronous metastases, and adverse events were manageable in both groups.
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| Milestones in Metastatic Prostate Cancer |
| Comron Hassanzadeh, MD, MPH |
| Comron Hassanzadeh reviewed key milestones in metastatic prostate cancer, highlighting advances in metastasis-directed and all-site radiotherapy. He emphasized that intermittent ADT combined with stereotactic body radiotherapy (CROP) shows potential for cure in low-volume disease, local prostate radiotherapy may benefit selected de novo metastatic patients, and metastasis-directed SBRT (RADIANT) can delay systemic therapy in oligoprogressive mCRPC. |
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