Outcomes of pelvic radiotherapy with boost strategies in high nodal-risk prostate cancer: A phase 2 prospective trial

Study Overview: Prospective single-arm trial evaluating long-term outcomes of definitive radiotherapy (RT) with whole pelvic radiotherapy (WPRT) and intraprostatic boost in high-and very high-risk prostate cancer patients, including those with N1 disease Efficacy Results: The 5-year biochemical progression-free survival (bPFS) was 76%, increasing to 80% when excluding N1 patients. Toxicity and Safety: Favorable safety profile with no grade 3-4 gastrointestinal toxicity and low rates of grade 2 genitourinary toxicity, comparable to or better than similar trials despite the use of focal boosts. Patient-Reported Outcomes (PROs): PROs up to five years post-RT showed low bother scores, though urinary symptoms were slightly worse than in trials with lower-risk populations, likely due to more intensive treatment and higher baseline symptom burden. Conclusions: Whole-pelvis radiotherapy with targeted dose escalation was well tolerated.The high proportion of patients not receiving an intraprostatic boost underscores methodological challenges and emphasises the need for standardised imaging interpretation and delineation guidelines.