{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:03:50Z","timestamp":1791821030655,"version":"4.3.4"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"Importance<\/jats:title>Postoperative radiotherapy remains underused for men with biochemical recurrence or adverse pathological features after radical prostatectomy (RP). Stereotactic body radiotherapy (SBRT) may improve utilization and poses potential radiobiological advantages.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate physician-reported late toxic effects and 2-year patient-reported outcomes (PROs) following post-RP SBRT.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This phase 2, single-arm trial was conducted in 2 academic centers in the US and included a comparator cohort. Men with post-RP prostate-specific antigen greater than 0.03 ng\/mL or adverse pathologic features were included. Data were collected from February 2018 to March 2021, and data were analyzed from January to October 2024.<\/jats:p><\/jats:sec>Interventions<\/jats:title>SBRT delivered at 30 to 34 Gy in 5 fractions to the prostate bed. Nodal irradiation, boost to gross disease, and\/or hormonal therapy were delivered per physician discretion.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Late toxic effects (more than 90 days after treatment) were graded according to Common Terminology Criteria for Adverse Events version 4.03. PROs were measured using Expanded Prostate Cancer Index-26. The proportion of men whose PROs had decrements greater than twice the threshold for minimal clinically important difference (MCID) at any point during the first 2 years were evaluated. The longitudinal PROs for men receiving SBRT was compared with a cohort of 200 men receiving postoperative conventionally fractionated radiotherapy (CFRT) using logistic regression, while adjusting for baseline scores, age, and receipt of nodal irradiation.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 100 patients treated with post-RP SBRT, the median (IQR) age was 68.5 (63.9-71.4) years, and the median (IQR) follow-up was 43 (37-53) months. Cumulative incidence of late grade 2 and 3 genitourinary toxic effects was 25% and 4%, respectively, and of late grade 2 and 3 gastrointestinal tract toxic effects was 3% and 3%, respectively. The proportion of patients with decrements more than 2-fold the MCID in PROs was 38.9% (37 of 95) for urinary incontinence, 17.9% (17 of 95) for urinary irritation, and 34.1% (31 of 91) for bowel function. Compared with the CFRT cohort, the adjusted odds ratio for patients receiving SBRT experiencing decrements more than 2-fold the MCID was 1.55 (95% CI, 0.87-2.76; P<\/jats:italic>\u2009=\u2009.14) for urinary incontinence, 0.94 (95% CI, 0.46-1.94; P<\/jats:italic>\u2009=\u2009.87) for urinary irritation, and 1.03 (95% CI, 0.57-1.84; P<\/jats:italic>\u2009=\u2009.93) for bowel function.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this nonrandomized clinical trial, post-RP SBRT was well-tolerated, with no measurably different decline in urinary or bowel PROs through 2 years compared with CFRT. Randomized studies and longer follow-up will better define the toxic effects and efficacy profile of post-RP SBRT.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT03541850<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2025.1059","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T11:01:17Z","timestamp":1747306877000},"page":"726","source":"Crossref","is-referenced-by-count":11,"title":["Patient-Reported Outcomes With Stereotactic Intensity Modulated Radiotherapy After Radical Prostatectomy"],"prefix":"10.1001","volume":"11","author":[{"given":"John","family":"Nikitas","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University of California, Los Angeles"},{"name":"Department of Radiation Oncology, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie 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