9038 Background: Job satisfaction and turnover intention remain crucial outcomes for healthcare organizations incurring substantial costs associated with recruiting and training new employees. Continual workplace stressors continue to challenge retention efforts across clerical and clinical settings. Leader-member exchange (LMX) theory provides a relationship-based framework for understanding these outcomes, emphasizing the quality of the manager-employee relationship. As healthcare workforce increasingly spans generational cohorts, differences in career expectations and workplace values may influence how leadership relationships are perceived. This study examines the association between LMX quality, job satisfaction, and turnover intention, with specific attention to generational differences between older (Baby Boomers and Generation X) and younger (Millennials and Generation Z) employees within a Radiation Oncology department. Methods: This quantitative study surveyed healthcare professionals (> 18 years) in a Radiation Oncology department at an academic medical center using purposive sampling. An anonymous, web-based survey was distributed via email and included standardized measures of leader-member exchange (LMX-7), job satisfaction, and turnover intention (TIS-6), along with demographic items. After electronic informed consent was obtained, the average for survey completion was 7.5 minutes. Data was collected over three months, de-identified, and analyzed using RStudio. Results: The survey achieved a 74% response rate, indicating broad representation of the department. Mean LMX scores were comparable between older (M = 4.04, SD = 1.06) and younger (M = 3.91, SD = 1.13) employees. Job satisfaction was modestly higher among younger respondents (M = 4.18, SD = 0.73) compared with older respondents (M = 4.00, SD = 0.82), whereas turnover intention was slightly higher in the older group (M = 1.56, SD = 0.87 versus M = 1.45, SD = 0.83). LMX was positively correlated with job satisfaction in both older (r = .58, p = .002) and younger (r = .59, p < .001) professionals. LMX demonstrated an inverse association with turnover intention in both groups, reaching statistical significance among older employees (r = -.57, p = .003) but not among younger employees (r = -.32, p = .069). Conclusions: Higher-quality LMX was associated with greater job satisfaction and lower turnover intention among both older and younger healthcare professionals. This emphasizes the importance of leadership relationships in workforce development and stability. These findings support the value of authentic leadership practices grounded in mutual respect and trust. Additionally, these findings highlight the need for future analyses to examine individual generational groups (e.g., Generation X versus Millennials) to better understand variations.

Purpose Recent publications have renewed interest in prophylactic pelvic radiation therapy for higher-risk prostate cancer, as well as dose escalation for magnetic resonance imaging (MRI)-defined intraprostatic lesions. Here, we explore the use of pelvic nodal irradiation with a 3-fraction stereotactic body radiation therapy (SBRT) boost to the prostate and seminal vesicles, with a simultaneous MRI-directed focal intraprostatic lesion-ablative microboost (MIB). Methods and Materials We evaluated an institutional registry of patients undergoing pelvic nodal radiation followed by an SBRT boost to the prostate and seminal vesicles from April 2021 to March 2023. The study was approved by the local institutional review board (study #00001269). All patients were treated with pelvic nodal irradiation followed by a 3-fraction SBRT boost. The prostate SBRT boost dose was primarily 2100 cGy in 3 fractions (an accommodated range of 1800-2100 cGy). A subgroup of 15 patients received an MIB to an additional dose of 2300 cGy in 3 fractions (range, 2100-2400 cGy). The distribution of adverse event grades for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Results Fifty-eight patients underwent pelvic nodal irradiation followed by an SBRT boost to the prostate, with the distribution of risk groups as follows: patients were either in the high (36.2%, n = 21) or very high (34.5% n = 20) risk groups, whereas those with known nodal disease (19.0%, n = 11) or intermediate risk (10.3%, n = 6) comprised the rest of the study population. Most patients received androgen-deprivation therapy. The prostate SBRT boost dose was primarily 2100 cGy in 3 fractions. Fifteen patients received an MIB to an additional dose of 2300 cGy in 3 fractions. A median follow-up of 8.7 months was used to document the incidence of GU and GI toxicity. The distribution of GI and GU toxicity showed no significant difference between the MIB and non-MIB subcohorts at either the acute (<90 days) or late (>90 days) time points. Two grade 3 toxicities were observed, both in the non-MIB cohort. Grade 2+ GI and GU toxicities were not significantly different between the 2 groups, as assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Conclusions In the early follow-up period, we observed no significant difference in GI or GU toxicity between those who underwent MIB and those who did not. These results suggest that MRI-directed SBRT MIB did not increase GI toxicity and may even reduce GU toxicity compared with standard treatment. Future research should explore long-term side effects, with attention to the Expanded Prostate Cancer Index Composite (EPIC) scores and oncologic outcomes of this novel method of dose escalation.

Pelvic nodal irradiation is often used for high-risk prostate adenocarcinoma. A commonly used alternative to low dose rate (LDR) brachytherapy, a 3-fraction SBRT boost with fiducial tracking may allow for better coverage of extracapsular extension and macroscopic seminal vesicle invasion. This study evaluates the practical impact of prior pelvic nodal irradiation on fiducial tracking during a subsequent 3-fraction robotic stereotactic body radiation therapy (SBRT) boost for high-risk prostate cancer and compares these outcomes to a cohort of patients undergoing definitive 5-fraction SBRT. In this institutional analysis, we prospectively collected fiducial tracking data for patients receiving a 3-fraction boost to the prostate and seminal vesicles after conventional nodal radiation. We also identified patients treated with 5-fraction SBRT with a low risk of nodal involvement. Monte Carlo estimates of the Fisher’s Exact Test assessed fiducial tracking loss. Continuous variables within the 5- and 3-fraction cohorts were compared using the Mann-Whitney Test. Changes in fiducial tracking and their association with pre-treatment factors were analyzed through the Kruskal-Wallis test and Monte Carlo for tracking patterns, and Spearman Correlation Coefficient and Mann-Whitney Test for deviations in tracking over 5 fractions. A total of 405 patients were treated from April 2021 to September 2023 with: (1) 5-fraction SBRT (n = 309, 76

Purpose:Screening colonoscopies (CS) performed before prostate stereotactic body radiation therapy (SBRT) allow for identifying synchronous malignancies and comorbid gastrointestinal (GI) conditions. Performing these procedures prior to radiation precludes the necessity of post-SBRT pelvic instrumentation, which may lead to severe toxicity and fistulization. We review compliance of CSs, incidence of GI pathology, and the impact of pretreatment CS findings on subsequent physician-reported toxicity and patient-reported quality of life (QoL). Methods and Materials:We reviewed an institutional database of patients treated for prostate cancer with SBRT including toxicity and QoL outcomes. A detailed review of pretreatment CS findings was reviewed including identification of diverticulosis, location of polyp resection, and presence of hemorrhoids. Pretreatment CS findings were then correlated with outcomes following SBRT. Results:Identification of comorbid GI conditions was a common event, with the presence of diverticulosis in 49.5% (n = 100), hemorrhoids in 67% (n = 136), and polyps in 48% (n = 98). More than half of patients with polyps removed had at least 1 removed from the rectosigmoid. Pretreatment CS did not introduce a delay in SBRT start date. Grade 1 toxicity was significantly lower in patients who underwent CS closer to the initiation of SBRT. There was no increased risk of physician-graded toxicity in the presence of diverticulosis, hemorrhoids, or polyps. Patient-reported GI QoL pattern in our screening cohort mimicked that seen in the previously published nonscreened population. There was no overt QoL detriment observed in patients who had GI pathology identified before SBRT. Conclusions:GI pathology identified in our elderly patient population was commonly identified on pretreatment CS. Screening CS may optimize bowel health for patients heading into radiation therapy. Toxicity and QoL for patients with GI pathologies identified on pretreatment CS do not preclude the delivery of prostate SBRT. We advocate for pretreatment CS in patients eligible prior to SBRT.

INTRODUCTION:High-volume (≥ 50 %) biopsy core involvement (HVCI) is an independent risk factor for unfavorable intermediate-risk prostate cancer by NCCN guidelines. The studies demonstrating increased recurrence in high-volume disease were conducted in an era of conventional fractionation, often without dose-escalation. In the SBRT era, we explore the value of this pathologic criteria in intermediate-risk disease. METHODS:A large institutional database was reviewed to identify patients diagnosed with localized intermediate-risk (Gleason Grade [GG] 2 and 3) disease, who were treated with definitive five-fraction SBRT without ADT. HVCI was analyzed (1) traditionally with all positive cores given equal weight as well as weighted with a positive core of GG1 to GG3 given (2) linearly and (3) exponentially increased weight. Oncologic outcomes were analyzed using Cox and linear regression analysis. RESULTS:From 2009 to 2018, 888 patients with intermediate-risk prostate cancer were treated with five-fraction SBRT monotherapy to a median dose of 3500 cGy. The majority (68 %) had GG2 disease. HVCI was present in the 22 % and was inversely related to prostate volume and directly related to T-stage. Biochemical disease-free survival (BDFS) was not significantly associated with HVCI in the cohort (p = 0.47) nor in the GG2 (p = 0.85) and GG3 (p = 0.26) sub-cohorts. Similarly, when linear or exponential weight was given to a core with higher-grade disease, there was no association with BDFS. Finally, PSA nadir was not associated with HVCI; however, time to PSA nadir (TTN) was negatively associated with HVCI in the GG3 sub-cohort (p = 0.04). CONCLUSION:With a median follow-up of 4.1 years, HVCI was not associated with BDFS following SBRT monotherapy, particularly in patients with otherwise favorable intermediate-risk disease (GG2). TTN analysis suggests that HVCI may remain prognostic in GG3 disease (by definition unfavorable intermediate-risk). Further work should prospectively confirm whether HVCI is unnecessary in risk-stratifying GG2 disease in the SBRT era.

PurposeModern literature has demonstrated improvements in long-term biochemical outcomes with the use of prophylactic pelvic nodal irradiation followed by a brachytherapy boost in the management of high-risk prostate cancer. However, this comes at the cost of increased treatment-related toxicity. In this study, we explore the outcomes of the largest cohort to date, which uses a stereotactic body radiation therapy (SBRT) boost following pelvic nodal radiation for exclusively high-risk prostate cancer.Methods and materialsA large institutional database was interrogated to identify all patients with high-risk clinical node-negative prostate cancer treated with conventionally fractionated radiotherapy to the pelvis followed by a robotic SBRT boost to the prostate and seminal vesicles. The boost was uniformly delivered over three fractions. Toxicity was measured using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Oncologic outcomes were assessed using the Kaplan–Meier method. Cox proportional hazard models were created to evaluate associations between pretreatment characteristics and clinical outcomes.ResultsA total of 440 patients with a median age of 71 years were treated, the majority of whom were diagnosed with a grade group 4 or 5 disease. Pelvic nodal irradiation was delivered at a total dose of 4,500 cGy in 25 fractions, followed by a three-fraction SBRT boost. With an early median follow-up of 2.5 years, the crude incidence of grade 2+ genitourinary (GU) and gastrointestinal (GI) toxicity was 13% and 11%, respectively. Multivariate analysis revealed grade 2+ GU toxicity was associated with older age and a higher American Joint Committee on Cancer (AJCC) stage. Multivariate analysis revealed overall survival was associated with patient age and posttreatment prostate-specific antigen (PSA) nadir.ConclusionUtilization of an SBRT boost following pelvic nodal irradiation in the treatment of high-risk prostate cancer is oncologically effective with early follow-up and yields minimal high-grade toxicity. We demonstrate a 5-year freedom from biochemical recurrence (FFBCR) of over 83% with correspondingly limited grade 3+ GU and GI toxicity measured at 3.6% and 1.6%, respectively. Long-term follow-up is required to evaluate oncologic outcomes and late toxicity.

Purpose Percentage of positive cores involved on a systemic prostate biopsy has been established as a risk factor for adverse oncologic outcomes and is a National Comprehensive Cancer Network (NCCN) independent parameter for unfavorable intermediate-risk disease. Most data from a radiation standpoint was published in an era of conventional fractionation. We explore whether the higher biological dose delivered with SBRT can mitigate this risk factor. Methods A large single institutional database was interrogated to identify all patients diagnosed with localized prostate cancer (PCa) treated with 5-fraction SBRT without ADT. Pathology results were reviewed to determine detailed core involvement as well as Gleason score (GS). High-volume biopsy core involvement was defined as ≥ 50%. Weighted Gleason core involvement was reviewed, giving higher weight to higher-grade cancer. The PSA kinetics and oncologic outcomes were analyzed for association with core involvement. Results From 2009 to 2018, 1590 patients were identified who underwent SBRT for localized PCa. High-volume core involvement was a relatively rare event observed in 19% of our cohort, which was observed more in patients with small prostates ( p < 0.0001) and/or intermediate-risk disease ( p = 0.005). Higher PSA nadir was observed in those patients with low-volume core involvement within the intermediate-risk cohort ( p = 0.004), which was confirmed when core involvement was analyzed as a continuous variable weighted by Gleason score ( p = 0.049). High-volume core involvement was not associated with biochemical progression ( p = 0.234). Conclusions With a median follow-up of over 4 years, biochemical progression was not associated with pretreatment high-volume core involvement for patients treated with 5-fraction SBRT alone. In the era of prostate SBRT and MRI-directed prostate biopsies, the use of high-volume core involvement as an independent predictor of unfavorable intermediate risk disease should be revisited.

315 Background: Invasive procedures including biopsies in freshly irradiated tissue is a known risk factor for high-grade toxicity. Screening colonoscopies (CS) are often performed before radiotherapy given the need to rule out comorbid gastrointestinal conditions and avoid untoward post radiotherapy instrumentation of the pelvis. We investigate the association of pre-treatment CS and the colonic finding therein with subsequent GI toxicity following SBRT for prostate cancer. Methods: An institutional registry of patients undergoing five-fraction prostate SBRT was interrogated to identify those who underwent screening CS prior to radiotherapy from Feb. 2021 – May 2023. Patients were categorized into those who did and did not undergo CS within 6 months of SBRT. A detailed analysis of CS findings including polyp resection as well as presence of diverticulosis and hemorrhoids was performed. Post-SBRT toxicity was evaluated using CTCAE v 5.0. Groups were compared using the chi-square or Fisher’s exact test for categorical variables. The Mann-Whitney test was used to compare groups for time from CS to SBRT and presented as median (25th, 75th percentiles). A result was considered significant at p < 0.05. Results: In this cohort, a total of 156 patients underwent prostate SBRT with the distribution of risk grouping was as follows: low 9% (n = 14), intermediate 67% (n = 104), and high 24% (n = 38). Of the entire group, a total of 138 patients underwent pre-treatment CS with a median time from CS to SBRT of 4 months. There was no difference in grade 1+ GI toxicity (67% vs. 61%, p = 0.60) in patients who did and did not undergo pretreatment CS. However, there was a significantly higher grade 2+ GI toxicity in patients who did not undergo pretreatment CS (45% vs. 15%, p = 0.03). Of the 138 subjects who underwent CS, time from CS to SBRT was not different between those who did and did not have any GI toxicity (4.6 months versus 3.3 months, p = 0.08) or between those who had grade 1 vs. grade 2+ toxicity (4.6 versus 4.7 months, p = 0.65). Notably, there was not an increased rate of GI toxicity in patients found to have diverticulosis (61.1% vs. 74.2%, p = 0.11), hemorrhoids (62.3% vs. 70.6%, p = 0.31), or resected polyps (70% vs. 64.7%, p = 0.51) on pre-SBRT CS. Finally, patients who had polyps resected in the rectosigmoid did not have a higher rate of GI toxicity versus those who under polyp resection elsewhere in the colon (57.6% vs. 71.4% respectively, p = 0.23). Conclusions: Pretreatment CS was not associated with an increased risk of GI toxicity following prostate SBRT, and in fact was associated with a lower rate of grade 2+ GI toxicity. Moreover, identification of polyps requiring resection (in the rectosigmoid or elsewhere), diverticulosis, and hemorrhoids on pretreatment CS did not result in excess GI toxicity following SBRT.

312 Background: The use of rectal spacers in the management of localized prostate cancer treated with definitive radiotherapy has become ubiquitous in recent years. However, pre-treatment MRIs often identify varying degrees of hydrogel involvement within the rectal wall. In the present study, we evaluate the geometry of spacer placement and its association with radiological rectal wall infiltration. Methods: We identified all patients who underwent hydrogel rectal spacer placement in preparation for 5-fraction prostate SBRT from 1/2020 to 9/2021. Two specialty trained body radiologists evaluated all MRIs independently. Scans were evaluated for the following spacer parameters: spacer thickness, prostate-rectal distance, symmetry, and degree of rectal wall infiltration. Prostate-rectal distance was measured at the level of the prostatic apex, midgland, and base. Symmetry of the rectal spacer was measured using right or left lateralization from midgland. Degree of rectal wall invasion was categorized as follows: none, muscularis, submucosal, and intraluminal. Results: A total of 336 patients underwent MRI following hydrogel rectal spacer placement from 1/2020 to 9/2021. Patients were excluded from MRI if they had AICD/pacemaker, foreign body, or patient refusal. In those patients with any rectal wall invasion, gel thickness as measured at the base (11 vs. 10 mm, p = 0.02), midgland (14 vs. 10 mm, p < 0.001), and apex (12 vs. 8 mm, P < 0.001) was significantly larger than those patients without invasion. This translated into significantly larger distances between the posterior aspect of the prostate and anterior aspect of the rectum at the level of the apex (12 vs. 8 mm, p < 0.001) and midgland (13 vs. 11, p < 0.001), but not at the base (14 vs. 14 mm, p = 0.5). There was no association seen with asymmetrical spacer placement and rectal wall invasion (p = 0.7). Subgroup analysis of patients with more extensive invasion into the muscularis or submucosa confirmed significantly larger gel thickness at all prostate levels, as well as a larger prostate-rectal distance at the level of the apex and midgland. Significant associations remained consistent with both independent radiological evaluations. Conclusions: Hydrogel spacer rectal wall infiltration was associated with increased axial gel thickness, specifically at the level of the prostatic midgland and apex. Rectal wall infiltration was not associated with lateralization of gel. Rectal infiltration may be a result of surplus hydrogel placed particularly in the region where the potential space between the prostate and the rectum is limited.

Purpose: Historically, toxicity concerns have existed in patients with large prostate glands treated with radiation therapy, particularly brachytherapy. There are questions whether this risk extends to stereotactic body radiation therapy (SBRT). In this retrospective review, we examine clinical outcomes of patients with prostate glands >= 100 cc treated curatively with SBRT. Methods and Materials: We retrospectively analyzed a large institutional database to identify patients with histologically con fi rmed localized prostate cancer in glands >= 100 cc, who were treated with de fi nitive-robotic SBRT. Prostate volume (PV) was determined by treatment planning magnetic resonance imaging. Toxicity was measured using Common Terminology Criteria for Adverse Events, version 5.0. Many patients received the Expanded Prostate Cancer Index Composite Quality of Life questionnaires. Minimum follow-up (FU) was 2 years. Results: Seventy-one patients were identi fi ed with PV >= 100 cc. Most had grade group (GG) 1 or 2 (41% and 37%, respectively) disease. All patients received a total dose of 3500 to 3625 cGy in 5 fractions. A minority (27%) received androgen deprivation therapy (ADT), which was used for gland size downsizing in only 10% of cases. Nearly half (45%) were taking GU medications for urinary dysfunction before RT. Median toxicity FU was 4.0 years. Two-year rates of grade 1+ genitourinary (GU), grade 1+ gastrointestinal (GI), and grade 2+ GU toxicity were 43.5%, 15.9%, and 30.4%, respectively. Total grade 3 GU toxicities were very limited (2.8%). There were no grade 3 GI toxicities. On logistic regression analysis, pretreatment use of GU medications was signi fi cantly associated with increased rate of grade 2+ GU toxicity (odds ratio, 3.19; P = .024). Furthermore, PV (analyzed as a continuous variable) did not have an effect on toxicity, quality of life, or oncologic outcomes. Conclusions: With early FU, ultra large prostate glands do not portend increased risk of high-grade toxicity after SBRT but likely carry an elevated risk of low-grade GU toxicity. (c) 2023 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.

You have accessJournal of UrologyCME1 Apr 2023PD15-12 IMPACT OF MRI DETECTED HYDROGEL SPACER RECTAL WALL INFILTRATION ON RADIATION-RELATED TOXICITY FOLLOWING 5-FRACTION PROSTATE STEREOTACTIC BODY RADIATION THERAPY Jonathan W. Lischalk, Jonathan A. Haas, Vianca Santos, Christopher Mendez, Astrid Sanchez, Ankur Doshi, David Sadowsky, Samir S. Taneja, Aaron Katz, and Angela Tong Jonathan W. LischalkJonathan W. Lischalk More articles by this author , Jonathan A. HaasJonathan A. Haas More articles by this author , Vianca SantosVianca Santos More articles by this author , Christopher MendezChristopher Mendez More articles by this author , Astrid SanchezAstrid Sanchez More articles by this author , Ankur DoshiAnkur Doshi More articles by this author , David SadowskyDavid Sadowsky More articles by this author , Samir S. TanejaSamir S. Taneja More articles by this author , Aaron KatzAaron Katz More articles by this author , and Angela TongAngela Tong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003262.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of rectal spacers in the treatment of localized prostate cancer treated with definitive radiotherapy has revolutionized the ability to minimize radiation dose to the rectum. In the present study, we investigate MRI identified rectal wall involvement and the subsequent clinical manifestations following prostate SBRT. METHODS: We identified all patient treated with 5-fraction SBRT for localized prostate cancer from 1/2020 to 9/2021 who underwent pre-treatment hydrogel rectal spacer placement. All MRIs were evaluated for the following spacer parameters: prostate-rectal distance, symmetry, and degree of rectal wall infiltration. Prostate-rectal distance was measured at the level of the prostatic apex, midgland, and base. Symmetry of rectal spacer was measured using right or left lateralization from midgland. Degree of rectal wall invasion was categorized as follows: none, muscularis, submucosal, and intraluminal. Radiation toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v5. RESULTS: A total of 336 patients underwent MRI following hydrogel rectal spacer placement from 1/2020 to 9/2021. The mean prostate-rectal distance measured at the apex, midgland, and base was 9 mm, 11 mm, and 14 mm, respectively. Spacer symmetry relative to midgland was within 0-10 mm in the vast majority of cases (n=289, 86%), and less commonly either 10-20 mm (n=42, 13%) or >20 mm (n=5, 1%). There was no MRI evidence of rectal wall invasion in the bulk of cases (n=229, 68%). For those with any invasion, the spacer commonly infiltrated only into the muscularis (n=83, 25%). However, in the remaining patients there was more dramatic evidence of invasion submucosally (n=21, 6%) or through the entire rectum into the luminal space (n=3, 1%). Of the patients who were found to have submucosal or intraluminal invasion, there were no patients who developed grade 2+ GI toxicity with a median follow up of 10.7 months (sans spacer historical rate of <4%). Of note, the only hydrogel placement parameter found to be significantly different in those patients with submucosal invasion or higher was midgland prostate-rectal distance (13 vs. 11 mm, p=0.04). CONCLUSIONS: Evidence of MRI detected hydrogel spacer rectal wall invasion is common and was observed in 32% of our cohort of 336 patient. However, only 7% of patients demonstrated rectal invasion beyond the muscularis, and in these cases we observed no grade 2 or higher CTCAE GI toxicity. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e423 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan W. Lischalk More articles by this author Jonathan A. Haas More articles by this author Vianca Santos More articles by this author Christopher Mendez More articles by this author Astrid Sanchez More articles by this author Ankur Doshi More articles by this author David Sadowsky More articles by this author Samir S. Taneja More articles by this author Aaron Katz More articles by this author Angela Tong More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: While prostate speci fi c antigen (PSA) bounce following radiation therapy for prostate cancer (PCa) treatment is well established, the parameters to predict this occurrence and differentiate it from biochemical recurrence (BCR) following stereotactic body radiotherapy (SBRT) are unknown. The purpose of this study is to investigate associations between pre- treatment and post-treatment variables among patients experiencing PSA bounce, BCR, or neither following SBRT. METHODS: An IRB-approved PCa database was reviewed for patients who underwent primary SBRT. Patients with less than 18 months of follow-up or were missing > 3 PSA measurements following SBRT were excluded. Patients were divided into outcome groups experiencing PSA bounce, BCR, or neither. PSA bounce was de fi ned as a rise of > 0.2 ng/mL over the pre-rise nadir followed by a decline without intervention. BCR was de fi ned by Phoenix criteria. Pre-treatment and post-treatment characteristics were analyzed between groups. Results that were signi fi cant when comparing PSA bounce to BCR were then analyzed in a multivariate logistic regression model to determine predictors for PSA bounce. RESULTS: We analyzed 170 men with a median age of 72 (52- 87) years with an average follow-up time of 75 þ 21 months, of which 28 (16%) experienced PSA bounce and 42 (25%) had BCR (Table 1). Pre- treatment D'Amico and Capra risk, Gleason group, PSA, prostate volume, prostate density and post-treatment PSA velocity were not associated with PSA bounce when compared to BCR or non-BCR/ bounce cohorts. Compared to those who did not experience PSA bounce/BCR, those with PSA bounce were younger (p < .05), had lower PSA doubling time (p < .001), and took longer to reach PSA nadir (p METHODS: A large single institutional database of 5,412 pa- tients was interrogated to identify all those who had detailed prostate biopsy information available. Patients were included who underwent de fi nitive fi ve-fraction SBRT for localized prostate cancer sans nodal irradiation prior 2019. who received androgen deprivation therapy were excluded from High-volume ” core involvement was de fi ned as (cid:3) 50% of biopsy cores involved with adenocarcinoma, as de fi ned by the NCCN. treated using a robotic radiosurgical platform fi ducial cant difference in PSA nadir between high- and low-volume disease was in the low risk cohort. of biopsy core involvement as it to PSA out- following curative SBRT. core involvement PSA following prostate SBRT intermediate OBJECTIVE: Neutrophil-to-lymphocyte ratio (NLR), a marker for subclinical in fl ammation, has been previously shown to be associated with erectile dysfunction (ED). Treatment of localized prostate cancer (PCa) is also associated with a greater risk of ED. In this study, we aimed to determine the potential predictive value of the NLR on ED after prostate brachytherapy (PB) for PCa. METHODS: Between July 2005 and January 2021, 842 patients were included in this retrospective study of a prospectively maintained database. ED was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) physician-reported scale. Patient characteristics and erectile function at last follow-up were compared for patients with a baseline NLR < 2 and (cid:3) 2. Univariate and multivariate analyses were performed to evaluate the predictive value of baseline NLR (cid:3) 2 on post-PB ED. RESULTS: Baseline NLR (cid:3) 2 was found to be a statistically signi fi cant predictor of post-PB ED on both univariate (p [ 0.002) and multivariate analyses (p [ 0.008). Furthermore, the difference in ED prevalence between the NLR < 2 and NLR (cid:3) 2 groups became more pronounced with longer follow-up after PB. The ED rate at 5 years post- PB was 43% for the NLR (cid:3) 2 group, compared to 29% for the NLR < 2 group.CONCLUSIONS: In a large cohort of patients with PCa who underwent PB, it was found that NLR was a predictor of post-treatment ED, even after adjusting for available covariates, including age and known risk factors for endothelial dysfunction.

Background The use of treatment planning prostate MRI for Stereotactic Body Radiation Therapy (SBRT) is largely a standard, yet not all patients can receive MRI for a variety of clinical reasons. Thus, we aim to investigate the safety of patients who received CT alone based SBRT planning for the definitive treatment of localized prostate cancer. Methods Our study analyzed 3410 patients with localized prostate cancer who were treated with SBRT at a single academic institution between 2006 and 2020. Acute and late toxicity was evaluated using the Common Terminology Criteria for Adverse Events version 5.0. Expanded Prostate Cancer Index Composite (EPIC) questionnaires evaluated QOL and PSA nadir was evaluated to detect biochemical failures. Results A total of 162 patients (4.75%) received CT alone for treatment planning. The CT alone group was older relative to the MRI group (69.9 vs 67.2, p < 0.001) and had higher risk and grade disease ( p < 0.001). Additionally, the CT group exhibited a trend in larger CTVs (82.56 cc vs 76.90 cc; p = 0.055), lower total radiation doses ( p = 0.048), and more frequent pelvic nodal radiation versus the MRI group ( p < 0.001). There were only two reported cases of Grade 3 + toxicity within the CT alone group. Quality of life data within the CT alone group revealed declines in urinary and bowel scores at one month with return to baseline at subsequent follow up. Early biochemical failure data at median time of 2.3 years revealed five failures by Phoenix definition. Conclusions While clinical differences existed between the MRI and CT alone group, we observed tolerable toxicity profiles in the CT alone cohort, which was further supported by EPIC questionnaire data. The overall clinical outcomes appear comparable in patients unable to receive MRI for their SBRT treatment plan with early clinical follow up.

PurposeAdvancements in breast radiation therapy offer innumerable benefits to patients and the health care system. Despite promising outcomes, clinicians remain hesitant about long-term side effects and disease control with accelerated partial breast radiation therapy (APBI). Herein, we review the long-term outcomes of patients with early-stage breast cancer treated with adjuvant stereotactic partial breast irradiation (SAPBI).Methods and MaterialsThis retrospective study examined outcomes of patients who received diagnoses of early-stage breast cancer treated with adjuvant robotic SAPBI. All patients were eligible for standard ABPI and underwent lumpectomy, followed by fiducial placement in preparation for SAPBI. Using fiducial and respiratory tracking to maintain a precise dose distribution throughout the course of treatment, patients received 30 Gy in 5 fractions on consecutive days. Follow-up occurred at routine intervals to evaluate disease control, toxicity, and cosmesis. Toxicity and cosmesis were characterized using the Common Terminology Criteria for Adverse Events version 5.0 and Harvard Cosmesis Scale, respectively.ResultsPatients (N = 50) were a median age of 68.5 years at the time of treatment. The median tumor size was 7.2 mm, 60% had an invasive cell type, and 90% were estrogen receptor positive, progesterone receptor positive, or both. Patients (n = 49) were followed for a median of 4.68 years for disease control and 1.25 years for cosmesis and toxicity. One patient experienced local recurrence, 1 patient experienced grade 3+ late toxicity, and 44 patients demonstrated excellent cosmesis.ConclusionsTo our knowledge, this is the largest retrospective analysis with the longest follow-up time for disease control among patients with early breast cancer treated with robotic SAPBI. With follow-up time for cosmesis and toxicity comparable to that of previous studies, results of the present cohort advance our understanding of the excellent disease control, excellent cosmesis, and limited toxicity that can be achieved by treating select patients with early-stage breast cancer with robotic SAPBI.

Purpose: Whole gland cryoablation is a guideline-approved definitive treatment for localized prostate cancer, and is being explored for partial gland ablation. However, there is limited data regarding management of cryoablation failures. Stereotactic body radiation therapy (SBRT) is a well-established method of primary treatment for prostate cancer. Here we review salvage SBRT after cryoablation failures. Methods and Materials: A large database of patients treated with definitive SBRT was interrogated to identify those who underwent primary cryoablation. All patients were determined to have progressive disease based on a rising prostate specific antigen and/or postcryoablation biopsy. All patients were treated with SBRT over 5 treatment fractions using a robotic radiosurgical platform. Baseline cryoablation characteristics and pre- and posttreatment Expanded Prostate Cancer Index Composite questionnaires were analyzed. Acute and late toxicity was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Cancer outcomes after salvage SBRT were stratified by disease and treatment characteristics. Results: A total of 51 patients were identified who underwent cryoablation followed by salvage SBRT. The majority (47%) were found to have intermediate-risk disease at the time of SBRT salvage and most commonly were treated with 3500 cGy in 5 fractions to the prostate and seminal vesicles. Only 1 grade 3+ toxicity was identified. Patient-reported quality of life metrics after SBRT salvage followed prior patterns observed in the de novo SBRT setting. With a median follow-up of 40 months, 76% of the cohort demonstrated disease control. Median time to prostate cancer recurrence was 57.5 months, and recurrence was predominantly seen in patients with underlying high-risk disease. Conclusions: This is the largest cohort of patients treated with any radiation therapy salvage after cryoablation and the first institution to report SBRT as a modality of salvage. Salvage SBRT after cryoablation results in low rates of high-grade toxicity, acceptable changes in patient-reported quality of life, and durable rates of long-term oncologic control.

You have accessJournal of UrologyCME1 May 2022PD22-10 HIGH VOLUME BIOPSY CORE INVOLVEMENT PREDICTS FOR ELEVATED PSA NADIR FOLLOWING DEFINITIVE SBRT IN INTERMEDIATE RISK PROSTATE CANCER Jonathan Lischalk, Astrid Sanchez, Christopher Mendez, Todd Carpenter, Moses Tam, Anthony Corcoran, Matthew Witten, Seth Blacksburg, Aaron Katz, and Jonathan Haas Jonathan LischalkJonathan Lischalk More articles by this author , Astrid SanchezAstrid Sanchez More articles by this author , Christopher MendezChristopher Mendez More articles by this author , Todd CarpenterTodd Carpenter More articles by this author , Moses TamMoses Tam More articles by this author , Anthony CorcoranAnthony Corcoran More articles by this author , Matthew WittenMatthew Witten More articles by this author , Seth BlacksburgSeth Blacksburg More articles by this author , Aaron KatzAaron Katz More articles by this author , and Jonathan HaasJonathan Haas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002564.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate SBRT has become one of the fastest growing radiation modalities used to treat localized prostate cancer in the United States. Randomized data including the HYPO-RT-PC, RTOG 0938, and PACE B trials have established its efficacy and safety. Given the larger radiobiological dose delivered using SBRT relative to conventional dose escalated regimens, the ablative capability of such SBRT is thought to be superior. As such, PSA nadirs following SBRT have been shown to be lower than those observed with conventional fractionation schedules. Here we explore the relationship between burden of disease based on pretreatment prostate biopsy core involvement and PSA nadir following definitive SBRT. METHODS: A large single institutional database of 5,412 patients was interrogated to identify all those who had detailed prostate biopsy information available. Patients were included who underwent definitive five-fraction SBRT for localized prostate cancer sans nodal irradiation prior 2019. Patients who received androgen deprivation therapy were excluded from analysis. “High-volume” core involvement was defined as ≥ 50% of biopsy cores involved with adenocarcinoma, as defined by the NCCN. All patients were treated using a robotic radiosurgical platform with fiducial tracking. RESULTS: A total of 2,034 patients were identified with a median age of 67 years. The risk group breakdown was as follows: low (n=610, 30%), intermediate (n=1,353, 67%), and high (n=71, 3%). The most common (n=1,842, 91%) prostate SBRT dose utilized was 3,500 cGy in 5 fractions. High volume core involvement stratified by risk group was as follows: low (n=82, 13.4%), intermediate (n=214, 15.8%), and high (n=6, 8.5%). With a median follow up of 16 months, there was a statistically significant increase in PSA nadir within the intermediate risk cohort found to have high-volume versus low-volume core involvement (0.9 vs. 0.8, p=0.001). No significant difference in PSA nadir between high- and low-volume disease was observed in the low risk cohort. CONCLUSIONS: To our knowledge, this is the first large scale analysis of prostate biopsy core involvement as it relates to PSA outcomes following curative SBRT. High volume core involvement is associated with higher PSA nadir following curative prostate SBRT for intermediate risk disease. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e407 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Lischalk More articles by this author Astrid Sanchez More articles by this author Christopher Mendez More articles by this author Todd Carpenter More articles by this author Moses Tam More articles by this author Anthony Corcoran More articles by this author Matthew Witten More articles by this author Seth Blacksburg More articles by this author Aaron Katz More articles by this author Jonathan Haas More articles by this author Expand All Advertisement PDF downloadLoading ...