S3041
Invited Speaker
ESTRO 2026
5441 ADT and beyond: evolving systemic strategies after
Dose: Typically 64–66 Gy to the prostate bed. Doses ≥ 66 Gy may improve biochemical control, especially in high-risk patients, but increase toxicity risk. Hypofractionation is under evaluation. Target volumes: The prostate bed is standard, defined by consensus guidelines and increasingly guided by MRI or PSMA PET data. Pelvic lymph node irradiation is considered for patients at high nodal risk but remains debated. Timing: Early SRT at low PSA levels (<0.5 ng/mL, ideally <0.2) is preferred. It offers outcomes comparable to adjuvant radiotherapy while avoiding overtreatment/toxicity. ADT use: Adding ADT improves outcomes in selected patients, particularly those with higher PSA or adverse features. Short-term (4–6 months) ADT is common, but benefits must be balanced against side effects. Overall, SRT should be individualized based on risk factors, patient characteristics and biomarkers based decision is needed. 5444 What Are We Optimising For? Outcomes That Matter to Older Adults undergoing Radiotherapy Lucinda Morris Radiation Oncology Network, Western Sydney Local Health District, Sydney, Australia Radiation therapy (RT) is a fundamental component of cancer care, contributing to approximately 40% of all cancer cures and indicated in over half of all patients with cancer. As the global population ages, the majority of patients seen in radiation oncology are older adults, and this proportion will continue to rise. RT is particularly well suited to this population due to its effectiveness, limited systemic toxicity, and increasing convenience, particularly through advances such as hypofractionation and stereotactic techniques. Despite this, outcomes for older adults with cancer remain poorer than for younger patients, even adjusting for comorbidity. There is a significant lack of high-quality evidence to guide optimal RT decision- making in this group, and older adults remain underrepresented in clinical trials. Importantly, the traditional trial endpoints measured often do not reflect what matters most to this unique population, including maintenance of function and independence, cognitive outcomes, treatment burden, and quality of life. This teaching lecture will explore outcomes that matter to older adults undergoing RT. It will examine key domains including functional decline, cognition, independence, and treatment burden, alongside the emerging concept of time toxicity, the time patients spend engaged in healthcare rather than living their daily lives.
prostatectomy Ashwin Sachdeva
Department of Surgery, The Christie Hospital, Manchester, United Kingdom. Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom Radical prostatectomy remains a cornerstone treatment for localised and locally advanced prostate cancer, yet a substantial proportion of patients with high-risk features will subsequently experience recurrence. This creates a central clinical challenge: how to identify the patients who are likely to require multimodal therapy, and when to introduce systemic treatment to reduce the risk of relapse or metastatic progression. Evidence for androgen deprivation therapy (ADT) in the post-operative setting has been variable, particularly in unselected populations. Recent data suggest that the benefit of ADT with salvage radiotherapy is not uniform, with no clear overall survival advantage in unselected patients and the greatest likelihood of benefit in men with higher risk disease features. This talk will review the rationale for systemic strategies after prostatectomy and how this field is evolving beyond conventional ADT alone. First, it will examine the strengths and limitations of established approaches, including adjuvant and early salvage treatment paradigms, and the persistent uncertainty regarding timing, patient selection, and overtreatment. Second, it will discuss how contemporary evidence is reshaping thinking around treatment intensification, including the potential role of novel systemic agents and biomarker-guided therapy in the peri-operative setting. Finally, it will consider how genomic alterations and tumour biology may help refine risk stratification and future management. 5442 Post-prostatectomy radiotherapy: balancing benefit, timing and side effects Paul Sargos Radiotherapy, Institut Bergonié, Bordeaux, France Salvage radiotherapy (SRT) after prostatectomy involves key decisions on dose, target volumes, timing, and androgen deprivation therapy (ADT) use. The aime of this lecture will be to describe current evidences and pending questions. A literature review has been perfomed to identify prospective trials encompassing all predifined questions.
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