S1291
Clinical - Urology
ESTRO 2026
Purpose/Objective: Prostate Specific Antigen (PSA) monitoring is essential for assessing treatment response and detecting biochemical recurrence (BCR) after radiotherapy (RT) for prostate cancer. PSA dynamics in the first-year post-RT are predictive of BCR. Guidelines (RCR, NICE, EAU1–3), evolving over 20 years, currently recommend testing within three-months of RT, followed by six- monthly intervals in the first-year. However, adherence remains inconsistent.We investigated (i) compliance with guideline-recommended PSA monitoring across centres, RT techniques, ADT use, and RT-year, (ii) association between early, consistent PSA monitoring and BCR outcomes. Material/Methods: Patient and tumour characteristics, repeat PSA measurements, and ADT dates were collected for men treated with RT+/-ADT at two UK centres between 2004-2024 (hypofractionation, brachytherapy boost, SABR). Compliance was defined as ≥ three measurements in the first-year post-RT, beginning within three-months1–3. Adherence was analysed by centre, RT-year, and ADT. Propensity score 1:1 matching balanced age, Gleason-grade-group, T-stage, baseline-PSA, ADT use, and RT-year between compliant and non-compliant groups. Only BCR events post 12-month were analysed. BCR (nadir+2 ng/ml) was assessed using Kaplan-Meier and multivariable Cox regression. Results: A total of 1,262 patients were included. Most (902, 71%) were treated 2004-2014, and 360 (29%) 2020– 2024, after most recent RCR guidelines in 2019. Overall, 70% received ADT (short-term ≤ 18-months: 613, long-term: 264), with consistent use over time. Baseline-risk was evenly distributed.PSA monitoring varied widely between centres (Figure 1A). Overall compliance was 14% (RT: 29/368, RT+ADT: 148/834) (Figure 1B). Most patients had two PSA measurements (n=706, 56%), 278 (22%) had one, 195 (15%) had three or four, 161 (13%) had none, and one had ten. First follow-up PSA ranged from three-weeks to six-years (mean 5.3-months, SD 5.1). Follow-up intervals varied by centre (p<0.0001) but was consistent between ADT, risk, and RT- year.
Conclusion: In this real-world cohort of MIBC patients unsuitable for or refusing RC, TMT provided effective bladder preservation and survival outcomes consistent with historical RC data. Hypofractionated radiotherapy was associated with significantly improved PFS compared to conventional fractionation, without compromising OS or tolerability. These results support hypofractionation as a viable treatment option within TMT, though larger prospective studies are needed for validation. Keywords: Bladder cancer ， Hypofractionation ， Organ-preserving Early, Consistent PSA Monitoring After Prostate Radiotherapy predicts Improved Outcomes: A Multicentre Study Jane Shortall 1,2 , Vodathi Bamunuarachchi 3 , Conor McGarry 4,5 , Guillermo Lorenzo 6,7 , Peter McHale 4,5 , Ananya Choudhury 3,1 , Peter Hoskin 3,1 , Kimberley Reeves 1 , Marcel van Herk 1,2 , Alan McWilliam 1,2 1 School of Medical Sciences, The University of Manchester, Manchester, United Kingdom. 2 Medical Physics, The Christie NHS Foundation Trust, Manchester, United Kingdom. 3 Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. 4 Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, Ireland. 5 Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast, Ireland. 6 Department of Mathematics, University of A Coruña, A Courna, Spain. 7 Oden Institute for Computational Engineering and Sciences, The University of Texas, Austin, USA Digital Poster 4202
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