Neha Vapiwala, MD, on intensifying radiotherapy in prostate cancer

In the following video, Neha Vapiwala, MD, FASTRO, discusses how radiation oncologists are approaching the integration of radiation therapy with systemic treatment intensification across different stages of localized and locally advanced prostate cancer. Vapiwala is a professor of radiation oncology at University of Pennsylvania, the dean of admissions and vice chair of education in the department of radiation oncology at the Perelman School of Medicine, and the president of ASTRO.

Vapiwala explained that for patients with early-stage localized prostate cancer, treatment with surgery alone or radiation alone is often sufficient depending on individual risk factors. However, in patients with higher-risk or truly locally advanced disease, combining radiation therapy with systemic therapy remains a well-established standard of care. In select cases with imaging or pathologic nodal involvement, clinicians may further intensify treatment with an androgen receptor pathway inhibitor.

She noted that modern radiation techniques have also improved the ability to safely and effectively target involved lymph nodes with highly conformal boosts, allowing for more precise treatment of known areas of disease. This approach reflects the growing role of advanced imaging and radiation delivery in tailoring therapy for patients with node-positive or otherwise higher-risk presentations.

Vapiwala also highlighted findings from the POSEIDON meta-analysis presented at the 2026 ASCO Genitourinary Cancers Symposium,¹ which she said reinforced current practice patterns in the post-prostatectomy biochemical recurrence setting. Among patients receiving early salvage radiotherapy with prostate-specific antigen (PSA) levels below 0.5 ng/mL, radiation alone appeared sufficient, as adding 6 months of androgen deprivation therapy did not improve overall survival. Although metastasis-free survival was improved with hormonal therapy, she emphasized that clinicians should individualize decisions based on patient age, high-risk pathologic features, PSA velocity, imaging results, and genomic classifier data.

REFERENCE