Urinary toxicity following radical prostatectomy (RP) and postoperative radiotherapy (RT) includes urinary incontinence and vesicourethral anastomosis (VUA) strictures. With the increasing use of stereotactic body radiotherapy (SBRT), dose-escalation, and reirradiation within the prostate bed (PB), standardization of the definition of urinary organs at risk (OARs) in the post-RP setting is needed.
This works aims to provide a comprehensive review of the anatomical and physiopathological changes occurring after RP, as well as to provide a consensus on urinary OARs delineation for prostate cancer (PCa) EBRT in the post-RP setting.
A multidisciplinary task force including three radiation oncologists, one uroradiologist, and two urologists was created in 2024. First, OARs potentially involved in urinary toxicity were identified and discussed. A literature review was performed, addressing several questions relative to surgical procedures and reconstructive strategies. A focus was also given to potential complications following RP and its impact on urinary OARs. Secondly, results were presented and discussed with a panel of radiation oncologists, members of the "Francophone Group of Urological Radiation Therapy" (GFRU). Thereafter, GFRU experts were asked to answer a dedicated questionnaire, including 26 questions on the controversial issues related to the delineation of urinary OARs.
The following structures were identified as critical for RT in the post-RP setting: bladder, bladder neck, bladder trigone, VUA, membranous urethra, striated sphincter. A consensus was reached for 25 out of 26 items.
New clinical scenarios at risk of toxicity in the post-RP setting are arising, including especially PB reirradiation with SBRT, PB SBRT, and dose-escalated RT within the PB. This consensus highlights contemporary urinary structures in the post-RP setting. It also proposes a standardized definition of urinary OARs for the development of future clinical trials.
Practical radiation oncology. 2025 Sep 04 [Epub ahead of print]
Jennifer Le Guevelou, Thomas Zilli, Arthur Peyrottes, Luc Beuzit, Ludovic Ferretti, Mario Terlizzi, Stephane Supiot, Verane Achard, Samuel Palumbo, Geneviève Loos, Jihane Boustani, Carl Salembier, Paul Sargos
Laboratoire du traitement du signal et de l'image, Université de Rennes, France. Electronic address: ., Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland., Department of Urology, Saint-Louis Hospital, Paris-Cité University, Paris, France., Department of Radiology, University hospital of Rennes, France., Department of Urology, clinique Bagatelle, Talence, France., Department of Radiation Oncology, Institut Gustave Roussy, France., Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France., Department of Radiation Oncology, Institut Bergonié, Bordeaux, France., Department of radiation oncology, Hôpital de Jolimont, La Louvière, Belgium., Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France., Department of Radiation Oncology, centre hospitalier universitaire de Besançon, Besançon, France., Department of radiation oncology, Europe Hospitals Brussels, Brussels, Belgium., Department of Radiation Oncology, Institut Bergonié, Bordeaux, France; Centre de Radiothérapie Charlebourg, La Défense, Groupe Amethyst, 65, avenue Foch, 92250 La Garenne-Colombes, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40914494