ESTRO 2025 - Abstract Book

S1925

Clinical - Urology

ESTRO 2025

Material/Methods: All men diagnosed with metastatic prostate cancer at the time of diagnosis in England from January 2018 to December 2021 were identified through the national cancer registry, with their records linked to hospital and radiotherapy treatment data. The analysis included patients with M1a or M1b disease. Patients who received radiotherapy to the prostate, in line with current guidelines, within twelve months were identified. Multivariable regression models were used to analyse the association between treatment and factors such as age, comorbidities, frailty, ethnic background, socioeconomic deprivation, rurality, year of diagnosis, PSA and Gleason score. Variation in treatment across the 47 specialist multidisciplinary teams (sMDTs), which are responsible for coordinating prostate cancer care in England, was also examined. Results: Among the 17,131 patients included in the analysis, 1,744 (10.2%) received radiotherapy to the prostate following approved fractionation schedules (Table). The use of radiotherapy to the prostate increased from 7.6% (n=345) of patients in 2018 to 12.8% (n=565) in 2021 but remained low. Radiotherapy was delivered to 19.4% of men with M1a disease compared to 9.2% of those with M1b disease. Age was a key factor even when adjusting for comorbidity and frailty: radiotherapy usage dropped from 15.3% among patients aged 75 or younger to 4.6% in those over 75. Radiotherapy treatment was found to decrease if men had multiple comorbidities, frailty, and lived in socioeconomically deprived areas (all p-values <0.05). There was no statistically significant association between radiotherapy use and ethnicity or rurality. The rate of radiotherapy use varied significantly across specialist prostate cancer teams (sMDTs), ranging from 1.6% to 18.0%, with the greatest variation observed in patients over 75, even after risk adjustment.

Conclusion: The study finds that rates of radiotherapy treatment to the prostate in mHSPC remain low despite recommendation in evidence based guidelines. There is also significant variation in treatment across sMDTs, indicating that many patients with mHSPC may not be receiving appropriate or optimal care, unrelated to comorbidity or fitness. Further work needs to assess how clinical decision making impacts on utilisation of treatment delivery to improve utilisation rates.

Keywords: metastatic, prostate, radiotherapy

References: 1. Parker, C.C., et al., Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. The Lancet, 2018. 392(10162): p. 2353-2366. 2. Boevé, L.M.S., et al., Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial. European Urology, 2019. 75(3): p. 410-418.