S1317
Clinical - Urology
ESTRO 2026
warranted to define optimal sequencing strategies and refine patient selection criteria. References: 1. Ost P et al. Eur Urol. 2015;67(5):852–63.2. Palma DA et al. Lancet. 2019;393(10185):2051–8.3. Siva S et al. Eur Urol. 2018;74(4):455–62.4. Tang C et al. JAMA Oncol. 2023;9(6):825–34. Keywords: Oligometastatic prostate cancer
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Metastasis-directed therapy in oligometastatic prostate cancer: long-term follow-up results from a monoinstitutional cohort. Ana Hompanera 1 , David Büchser 1 , Ainhoa Garay Benitez 2 , Libe del Castillo 1 , Teresa Espina 1 , Fernanda Aguirre 1 , Jon Cacicedo 1 , Alfonso Gomez-Iturriaga 1 1 Radiation Oncology, Hospital Universitario Cruces, Barakaldo, Spain. 2 Universidad del Pais Vasco, Universidad del Pais Vasco, Bizkaia, Spain Purpose/Objective: Prostate cancer is one of the most prevalent malignant diseases in men. Oligometastatic prostate cancer represents an intermediate stage between localized and disseminated disease. Emerging evidence suggests that metastasis-directed therapy (MDT), particularly stereotactic body radiotherapy (SBRT), may enhance disease control and survival. This study aimed to evaluate the clinical outcomes, biochemical relapse-free survival (BRFS), overall survival (OS), and treatment-related toxicity in patients with oligometastatic prostate cancer treated with MDT in a monoinstitutional cohort. Material/Methods: A retrospective analysis was performed on 132 patients with oligometastatic prostate cancer ( ≤ 5 lesions) treated with MDT, including SBRT or intensity- modulated radiotherapy (IMRT), between 2013 and 2025. Clinical and treatment data were analyzed, including biochemical response, recurrence patterns, and survival endpoints. Survival outcomes—BRFS, OS, castration resistance-free survival (CRFS), and cancer- specific survival (CSS)—were estimated using the Kaplan–Meier method. Treatment-related adverse events were graded according to standard toxicity criteria. Results: At a median follow-up of 47 months, 71.2% of patients experienced biochemical relapse, with a median BRFS of 19 months. Five-year OS and CSS rates were 77.4% and 89.1%, respectively. Treatment tolerance was excellent, with only 11.36% of patients developing mild (grade 1) toxicity and no reported grade ≥ 2 adverse events. Recurrent disease occurred in a substantial proportion, yet repeated MDT provided durable disease control in selected individuals, delaying the need for systemic therapy. Conclusion: MDT demonstrates favorable oncological outcomes and minimal toxicity in patients with oligometastatic prostate cancer, supporting its role in disease control and postponement of systemic treatment. Although recurrences remain frequent, the iterative use of MDT may offer sustained benefits in appropriately selected patients. Further randomized prospective studies are
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Age and acute toxicity after prostate radiotherapy: a pragmatic real-world analysis adjusted for rectal dose exposure Milos Grujic 1,2 , Neda Milosavljevic 1,2 , Jelica Grcak 2 , Emilija Subanovic 1,2 , Ivana Vujinovic 1,2 , Aleksandra Dugalic 1,2 , Katarina Jankovic 2 , Katarina Krasic 2 , Marija Zivkovic Radojevic 1,2 1 Department of Clinical Oncology, Faculty of Medical Sciences, Kragujevac, Serbia. 2 Center for Radiation Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia Purpose/Objective: Whether chronological age independently influences early tolerance to prostate radiotherapy remains uncertain, as previous studies report mixed associations after adjusting for dose–volume factors [1,2]. We evaluated age-related patterns of acute gastrointestinal/genitourinary (GI/GU) toxicity in a real- world cohort and tested whether any age effect persists after adjusting for rectal dose exposure. Material/Methods: We retrospectively analysed 162 men treated with curative-intent external-beam radiotherapy (76–78 Gy in 2-Gy fractions). The primary endpoint was any acute GI/GU toxicity (CTCAE v5.0) recorded during treatment or within 3 months post-RT [3]. Patients were grouped into predefined age bands (<65, 65–69, 70–74, ≥ 75 years). Candidate variables included age, rectal V50 and V60 Gy, bladder V65 Gy, and baseline clinical factors (PSA, hormonal therapy, and comorbidity index). Group differences across age strata were tested using χ² for trend, and a multivariable logistic model identified independent predictors of toxicity. Model discrimination was quantified by the area under the ROC curve (AUC). Results: Median age was 69 years (IQR 66–75); 24/162 (14.8%) experienced acute toxicity. Toxicity increased across age bands: 6% (<65 y), 12% (65–69 y), 19% (70–74 y), and 22% ( ≥ 75 y) (p=0.042, trend). In multivariable analysis, both age (OR 1.05 per year; 95% CI 1.00–1.11; p=0.048) and rectal V60 Gy (OR 1.07 per 1% increase; 95% CI 1.01–1.14; p=0.017) independently predicted acute toxicity. The combined model showed good
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