S2991
Invited Speaker
ESTRO 2026
based cancer care. Perspectives from the south Asian edition of Advanced Prostate Cancer Consensus Conference (APCCC) held in India in 2025 reveal broad agreement with the global consensus over major treatment pathways. However, a few key contrasts are also revealed, especially regarding the use of PSMA- PETCT, stereotactic radiotherapy for localised disease, and systemic therapy in locally advanced disease. A more aggressive approach in first-line management, and cost efficiency are major considerations in resource-constrained settings. A prudent balance between evidence and feasibility is required to adapt global consensus recommendations for local ecosystems. Collaborative efforts in LMICs need to be organised and encouraged to generate population- specific evidence and solutions. 5288 Metastatic prostate cancer: The added value of radiotherapy Piet Ost Department of radiation oncology, Iridium Network, Wilrijk, Belgium The therapeutic landscape for metastatic prostate cancer (mPC) has shifted from exclusively systemic treatments to multimodal approaches incorporating radiotherapy (RT). This presentation aims to comprehensively evaluate the evolving role and added value of RT in mPC, spanning both metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC). The primary objective is to equip attendees with an evidence-based framework for integrating RT to the primary tumor and metastasis-directed therapy (MDT) into modern clinical workflows. This session will critically review recent high-level evidence and landmark trials that are redefining the standard of care. The first segment will analyze data supporting cytoreductive prostate RT, prominently featuring the STAMPEDE/HORRAD/SWOG/PEACE trials. The second segment will evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for oligometastatic disease. This will center on an in-depth examination of the recent WOLVERINE individual patient data meta-analysis—an international collaboration that pooled data from multiple randomized controlled trials to comprehensively assess MDT across the mPC disease spectrum. Attendees will explore key findings demonstrating the disease-modifying impact of RT. Regarding primary tumor treatment, this part will highlight the significant overall survival (OS) benefit achieved by delivering prostate RT to patients with low-volume de novo mHSPC, alongside optimal patient selection criteria. Regarding MDT, the WOLVERINE meta-analysis will be
geometry-guided and dose-guided approaches, advanced techniques to account for deformation, AI- based methods and quality assurance consideration. Finally, the session will discuss real-time dose reconstruction, covering adaptive dose calculation, dose accumulation across fractions, and the QA and validation challenges that must be addressed for safe clinical implementation. 5285 Integrating systemic and local therapies: Lessons from APCCC Silke Gillessen Oncology, IOSI/EOC, Bellinzona, Switzerland At the Advanced Prostate Cancer Consensus Conference (APCCC), topics that directly impact daily practice but where no strong data or conflicting evidence exist, are discussed with a panel of international and multi-disciplinary experts. These experts, for 2026 more than 120, vote before the conference on a set of pre-defined multiple-choice questions. Including also questions on how to integrate systemic and local therapies in different settings. Consensus voting at the APCCCs is performed by panel members who are physician experts and who engage directly in clinical decision-making. At ESTRO the results of some of these specific consensus votings will be shown and discussed. The goal of this presentation is that the discussed results of these votings may help clinicians in shared and multidisciplinary decision-making, especially in situations where high-level evidence is scant or conflicting. Results of votings with consensus will be shown with the definition of consensus being when ≥ 75% agreement on an answer option was reached. However, also results of votings where no consensus was reached will be discussed, since these votings show where the gaps in current knowledge are and help to identify topics and settings where clinical studies should be planned and performed. 5287 Prostate cancer care: A global perspective Vedang Murthy Radiation Oncology, Tata Memorial Centre, Mumbai, India Prostate cancer, the most common malignancy in males worldwide, shows considerable differences in diagnosis, evaluation, and management globally. Socioeconomic gaps between the high-income and low-middle income countries (LMIC) translate to difficulties in implementing screening, early diagnosis, therapeutic decision-making, and access to evidence
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