Clinical genitourinary cancer · 2026
Second-Line Radiation Therapy for Locally Recurrent Prostate Cancer After Focal Therapy: A Single Institution Matched-Pair Analysis.
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Ewongwo Agnes, Kalahasti Nikitha V, Hui Caressa, Taparra Kekoa, Sonn Geoffrey, Ghanouni Pejman, Bagshaw Hilary P, Buyyounouski Mark K
Аннотация
BACKGROUND: Focal therapy (FT) is an alternative to prostate radiation therapy (RT) that targets a single intraprostatic tumor. When FT fails, second-line, whole-prostate radiation therapy (SRT) is considered; however, limited safety data is available. We report toxicity outcomes in patients undergoing SRT after FT.
METHODS: Retrospective analysis of 5606 prostate cancer patients evaluated from 2000 to 2024. Toxicities of patients who underwent SRT after FT were compared to patients treated with RT-alone. Propensity score matching balanced baseline patient and tumor characteristics. Differences in acute and late toxicities between cohorts were compared.
RESULTS: A total of 114 matched patients were analyzed (38 SRT, 76 RT-alone). Among SRT patients, 71% received high-intensity focused ultrasound, 18% cryoablation, 10.5% TULSA, and 3% focal laser ablation. Median time from FT to SRT was 3.3 years (IQR 2.0-5.1). RT modality differed significantly (P < .001), with higher use of EBRT-alone (82% vs. 62%)in the SRT group. Acute grade ≥ 2 GU toxicity occurred in 47% of SRT patients versus 32% in RT-alone (P = .11); no grade ≥ 3 GU events occurred. Acute GI toxicity rates were also similar: 10.5% (SRT) versus 8% (RT-alone; P = .7), with no grade ≥ 3 events. Late grade ≥ 2 GU (42% vs. 33%; P = .4) and GI (8% vs. 6.6%; P = .9) toxicities were not significantly different between groups. Progression free survival, prostate cancer specific survival, and local recurrence was not significantly different between cohorts.
CONCLUSIONS: Acute and late GI and GU toxicities were comparable between the SRT and RT-alone cohorts. These findings support SRT as a safe and acceptable treatment option.
METHODS: Retrospective analysis of 5606 prostate cancer patients evaluated from 2000 to 2024. Toxicities of patients who underwent SRT after FT were compared to patients treated with RT-alone. Propensity score matching balanced baseline patient and tumor characteristics. Differences in acute and late toxicities between cohorts were compared.
RESULTS: A total of 114 matched patients were analyzed (38 SRT, 76 RT-alone). Among SRT patients, 71% received high-intensity focused ultrasound, 18% cryoablation, 10.5% TULSA, and 3% focal laser ablation. Median time from FT to SRT was 3.3 years (IQR 2.0-5.1). RT modality differed significantly (P < .001), with higher use of EBRT-alone (82% vs. 62%)in the SRT group. Acute grade ≥ 2 GU toxicity occurred in 47% of SRT patients versus 32% in RT-alone (P = .11); no grade ≥ 3 GU events occurred. Acute GI toxicity rates were also similar: 10.5% (SRT) versus 8% (RT-alone; P = .7), with no grade ≥ 3 events. Late grade ≥ 2 GU (42% vs. 33%; P = .4) and GI (8% vs. 6.6%; P = .9) toxicities were not significantly different between groups. Progression free survival, prostate cancer specific survival, and local recurrence was not significantly different between cohorts.
CONCLUSIONS: Acute and late GI and GU toxicities were comparable between the SRT and RT-alone cohorts. These findings support SRT as a safe and acceptable treatment option.