National survey of radiotherapy and androgen deprivation therapy strategies with PSMA-PET/CT integration in intermediate-risk prostate cancer: TROD 09-007 study.

BACKGROUND

Intermediate-risk prostate cancer (IR-PC) represents a heterogeneous group requiring nuanced treatment approaches, and recent advancements in radiotherapy (RT), androgen deprivation therapy (ADT), and prostate-specific membrane antigen positron emission tomography (PSMA-PET/CT) imaging have prompted growing interest in personalized, risk-adapted management strategies. This study by the Turkish Society for Radiation Oncology aims to examine radiation oncologists' practices in managing IR-PC, focusing on RT and imaging modalities to identify trends for personalized treatments.

METHODS

A cross-sectional survey was conducted among Turkish radiation oncologists treating at least 50 prostate cancer (PC) cases annually. The 22-item questionnaire covered IR-PC management aspects such as risk stratification, imaging preferences, androgen deprivation therapy (ADT) use and duration, RT techniques, and treatment combinations. Anonymous responses were analyzed using descriptive statistics.

RESULTS

Thirty radiation oncologists participated, 57% with over 20 years of experience. The median annual number of PC cases treated was 130. For risk stratification, 43% followed the National Comprehensive Cancer Network (NCCN) guidelines, while 30% used the D'Amico classification. Imaging preferences revealed 47% favored PSMA-PET/CT. External beam RT was universally preferred, with 60% adopting ultra-hypofractionation. ADT was used by 97%, with 73% recommending it for unfavorable IR-PC cases. Short-term ADT (4-6 months) was the standard, administered concurrently with RT by 57%. Cardiovascular status influenced decisions for 97% of respondents, while 37% also considered patient age, preferences, and sexual health.

CONCLUSIONS

This national survey demonstrates a shift toward personalized care in intermediate-risk prostate cancer in Turkey, marked by selective PSMA-PET/CT use, tailored ADT, and evolving radiotherapy practices. The findings underscore the importance of multidisciplinary collaboration-particularly between urologists and radiation oncologists-to optimize imaging integration and treatment outcomes.