Management of high-risk prostate cancer in Spain: results from a national patterns of care survey.

[OBJECTIVE] The management of high-risk (HR) prostate cancer represents a challenge for radiation oncologists. This survey investigates the pattern of care in management of HR-prostate cancer across Spanish institutions.

[MATERIALS AND METHODS] We conducted a survey among URONCOR members from March to May 2024. This survey was structured in five sections: diagnosis, radiotherapy, hormonal treatment, follow-up, and future perspectives.

[RESULTS] A total of 74 responses from 71 different hospitals were received. Participants have a median professional experienced of 11 years, working most of them (84.9%) in public university hospitals. 97.3% have multidisciplinary tumor board and treat a median of 50 (0-200) HR-prostate cancer patients per year/department. 44.63% of centers use Choline-PET and 28.4% PSMA-PET at diagnosis with 26 different fractionation schedules, the most common is moderate hypofractionation (52.7%): 70 Gy in 28 fractions, followed by 37.5 Gy in 15 fractions + 15 Gy brachytherapy boost (30.4%). 56.8% of the institutions perform whole-pelvic irradiation in N0 patients, with 50.4 Gy in 28 fractions (40.48%) being the most common scheme. 56.8% prescribe an LHRH agonist and 74.6% for 24 months. 75.7% prescribe abiraterone in very high-risk patients. 63.0% use the PHOENIX-criteria to define a recurrence. 38.0% perform PSMA-PET and 39.0% Choline-PET as imaging for recurrence. After local relapse, 73.97% apply a re-irradiation technique with 11 different schedules (32.35%), with HDR-brachytherapy: 13.5 Gy × 2 being the most used (56.16%). 83.8% consider that they achieved good results in HR-prostate cancer.

[CONCLUSION] This study represents the current status of the management of HR-prostate cancer in Spain, highlighting the wide variety of radiotherapy treatments as well as the need for national consensus guidelines.