S1146
Clinical - Urology
ESTRO 2026
control. The low toxicity observed underscores the role of image-guided, PSMA-PET–adapted planning, which by 2025 guided nearly 70% of treatments. Hypofractionation reduced overall treatment time by 30–40%, improving accessibility and adherence within hybrid delivery systems. Conclusion: Hypofractionated SRT is a safe, efficient, and clinically robust approach for biochemical recurrence, achieving excellent acute tolerance and workflow efficiency. We are moving in the right direction—earlier, image- guided, and biologically optimized—but refinement through adaptive planning, AI-based prediction, and prospective validation is essential to reach a truly individualized standard of care. Keywords: Biochemical Recurrence Radiotherapy Non-Invasive Urodynamic Analysis of Prostatic Urethral Lift with Stereotactic Radiotherapy for Prostate Cancer and Benign Prostate Hyperplasia Aurelie Garant 1 , Young Suk Kwon 1 , Neil B Desai 1 , Raquibul Hannan 1 , Ryan Mauck 2 , Jennifer Tse 2 , Kris Gaston 2 , Shaghayegh Rezaie 1 , Katelyn Heney 1 , Daniel Yang 1 , Claus G Roehrborn 2 , Robert D Timmerman 1 , MinJae Lee 3 , Solomon L Woldu 2 1 Radiation Oncology, UT Southwestern Medical Center, Dallas, USA. 2 Urology, UT Southwestern Medical Center, Dallas, USA. 3 Biostastistics, UTHealth Houston McGovern Medical School, Houston, USA Purpose/Objective: Many men with bothersome benign prostatic hyperplasia (BPH) cannot undergo stereotactic ablative radiotherapy (SAbR) for prostate cancer (PCa) out of concern for obstructive urologic complications. However, the Prostatic Urethral Lift (PUL)—an established, minimally invasive BPH intervention—can relieve urinary obstruction without the morbidity of traditional surgery, potentially expanding the pool of patients eligible for SAbR. Our study aims to evaluate the safety and feasibility of integrating PUL with a spacer gel and SAbR in men with PCa who have BPH- related obstructive urinary symptoms. In this analysis, we explore longitudinal, non-invasive urodynamic changes in this patient cohort. Material/Methods: In this Phase I, non-blinded, single-arm safety trial, we enrolled 15 patients. Men were excluded if they had an estimated prostate volume greater than 100 g, any prior prostatic surgical intervention, previous Poster Discussion 548 androgen deprivation therapy, or a prostate-specific antigen (PSA) level above 20 ng/mL. Under general anesthesia, all patients underwent simultaneous implantation of the PUL device, a rectoprostatic spacer
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Hypofractionated Salvage Radiation Therapy in Biochemical Recurrence of Prostate Cancer: Acute Toxicity and Timing Insights Nicole Arbex 1 , Pedro Umpierre 1 , Franco Canary 1 , Ramon Ferrari 1 , Leo Oliveira 1 , Eduardo Fuks 1 , Guilherme Barbosa 1 , Julio Melo 2 , Paulo Canary 1 , Carlos Almeida 1 , Daniel Przybysz 1 1 Department of Radiation Oncology, Radioserra, Petrópolis, Brazil. 2 Department of Clinical Oncology, CTO, Petrópolis, Brazil
Purpose/Objective: Biochemical recurrence (BCR) after radical
prostatectomy remains a major challenge in prostate cancer management. Salvage radiotherapy (SRT) is the only curative option for localized recurrence, but the ideal timing and dose-fractionation are debated. Randomized trials—NRG-GU003 (HYPORT), RADICALS- RT, and SPPORT—showed that hypofractionated SRT (hSRT) achieves non-inferior control and late toxicity versus conventional schedules while reducing treatment time. Real-world studies (POPART 2024, TROG 22.04, Uro-RT 2025) confirmed the safety and practicality of moderate hypofractionation (2.5–3.0 Gy/fx) with IGRT and PSMA-PET–guided planning. This study assessed acute toxicity, timing, and clinical implications of hSRT in two large hybrid institutions integrating public and private networks. Material/Methods: We retrospectively analyzed patients with BCR treated from January 2023 to June 2025 at RádioSerra (Petrópolis, RJ) and RadioVitae (Campo Grande, RJ). Eligibility: prior prostatectomy, PSA >0.2 ng/mL or persistent detectability, and no metastases. Regimens included 52.5 Gy/20 fx, 55 Gy/22 fx, or 66 Gy/30 fx, delivered with daily IGRT and PSMA-PET–based contouring. Acute genitourinary (GU) and gastrointestinal (GI) toxicities were graded by CTCAE v5.0 within six weeks post-treatment. Patients were stratified as early ( ≤ 12 months post-surgery or PSA ≤ 0.3 ng/mL) or delayed (>12 months or PSA >0.3 ng/mL). Descriptive statistics and Fisher’s exact tests compared timing and toxicity outcomes. Results: Among 180 patients (median age 68 years, Gleason GG3–4), the median surgery-to-SRT interval was 18 months and median PSA 0.41 ng/mL. Acute GU or GI toxicity occurred in 37.2% (95% CI 30.5–44.5), urinary frequency or urgency in 22.2%, dysuria in 12.2%, and GI discomfort in 2.8%. No grade ≥ 3 events were recorded. Early hSRT was associated with lower PSA (0.28 vs 0.54 ng/mL; p=0.03) and fewer grade ≥ 2 GU events (18% vs 33%; p=0.04). These findings parallel NRG-GU003 and POPART 2024, confirming that early hSRT maintains tolerability while enhancing disease
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