Author

F. Barletta

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Review Open access Aug 2026

Whole-pelvic Versus Prostate-only Radiotherapy in Clinically Node-negative High-Risk Localised Prostate Cancer: A Systematic Review and Meta-analysis with Reconstructed Individual-patient Data.

SEARCH STRATEGY AND SOURCES OF INFORMATION MEDLINE, Embase and ClinicalTrials.gov were searched from database inception to May 2026 without language restriction, supplemented by hand-searching the proceedings of major oncology and radiation-oncology congress (2020-2026). AIMS Whether elective whole-pelvic radiotherapy (WPRT) improves outcomes over prostate-only radiotherapy (PORT) in high-risk localised prostate cancer remains an open question. We synthesised all phase 3 randomised trials and added a reconstructed individual-patient-data (IPD) analysis. MATERIALS AND METHODS We included phase III randomised trials of WPRT versus PORT. Trial-reported hazard ratios (HRs) were pooled using a random-effects meta-analysis, and individual-patient data were reconstructed (Guyot algorithm) and pooled. Outcomes were overall survival, biochemical/progression-free survival, and metastasis-free survival; risk of bias (RoB 2) and certainty (GRADE) were assessed for each outcome. RESULTS Five trials (5172 patients) were included. WPRT did not improve overall survival (HR, 1.07; 95% confidence interval [CI], 0.94 to 1.21; I2 = 0%; prediction interval, 0.92 to 1.24; reconstructed-IPD HR, 0.98; 0.80 to 1.20). The apparent benefit in biochemical/progression-free survival (HR, 0.84; 0.54 to 1.29) and metastasis-free survival (HR, 0.92; 0.54 to 1.57) was driven entirely by a single prostate-specific membrane antigen (PSMA)-staged, single-centre trial; excluding it, both became null (0.90; 0.77 to 1.06 and 1.00; 0.70 to 1.43). WPRT modestly increased late grade ≥2 genitourinary and gastrointestinal events without a meaningful severe-event excess. Certainty was moderate for overall survival and very low for both biochemical/progression-free and metastasis-free survival. CONCLUSION Current randomised evidence does not demonstrate sufficient benefit to support routine elective pelvic irradiation: WPRT does not improve overall survival, and its apparent benefit in progression-related endpoints is not reproducible across trials. POP-RT identifies a clinically plausible subgroup (patients with very-high nodal-risk who were PSMA-staged) in whom benefit is unproven and requires prospective validation in contemporary randomised trials.

J. Subiela, E. G. Sellés, F. L. Campos et al. · Clinics in oncology · 0 citations

Aug 2026

Cancer-specific mortality in high-risk or very high-risk prostate cancer patients treated with focal therapy vs. radical prostatectomy.

INTRODUCTION Focal therapy (FT) in high-risk or very high-risk prostate cancer (CaP) is not guideline-recommended. However, it may be occasionally used, but its effect on cancer-specific mortality (CSM) relative to standard treatment options such as radical prostatectomy (RP) is unknown and was addressed in the present study. METHODS In the Surveillance, Epidemiology, and End Results (SEER) database (2010-2022), high-risk or very high-risk CaP patients according to the National Comprehensive Cancer Network (NCCN) guidelines, treated with either FT or RP, were identified. A multivariable logistic regression (MLR) model assessed the associations between sociodemographic characteristics and receipt of FT. Multivariable competing risks regression (CRR) models, after 1:1 propensity score matching (PSM), tested for CSM differences after adjustment for other cause mortality (OCM). RESULTS Overall, 20,192 high-risk or very high-risk CaP patients treated with FT or RP were identified. Of those, 416 (2.0%) underwent FT and 19,776 (98.0%) RP. In the MLR model, rural area of residence and unmarried status predicted a 2.4-fold (P < 0.001) and 1.8-fold (P < 0.001) higher likelihood of receiving FT, respectively. In PSM analysis, 416 FT patients could only be matched with one RP control from 19,776 RP patients. After 1:1 PSM, at 120 months of follow-up, CSM after RP was 9.2 vs. 16.0% after FT. The corresponding OCM rates were 19.5 after RP vs. 31.5% after FT. In multivariable CRR models adjusted for OCM, FT increased CSM in a 2.0-fold fashion (mHR: 1.98; 95% CI: 1.17-3.34; P = 0.011). CONCLUSION Despite lack of guidelines endorsement, occasional high-risk or very high-risk CaP patients may be treated with FT. Specifically, rural and unmarried patients with high-risk or very high-risk CaP are more likely to receive guideline-discordant FT. Such practice doubles the risk of CSM relative to RP, and its use should therefore be discouraged in this patient population.

L. Quarta, M. Petix, M. Filzmayer et al. · Urologic oncology · 0 citations