Referral Pathways and Practical Takeaways for Prostate Radiotherapy

In the final installment in this series, Aurelie Garant, MD, describes candidate selection for her combined-procedure study as focused on on-label indications for prostatic urethral lift (UroLift), including gland sizes below 100 g and International Prostate Symptom Score thresholds drawn from hypofractionation trial data. She notes that patients who need to reach the bathroom before their appointment even starts are often good candidates. She also flags caution around combining SAbR with more destructive benign prostatic hyperplasia procedures like transurethral resection of the prostate, pointing to mixed literature on late-grade hematuria and incontinence risk when high-dose radiation follows significant tissue disruption.

Asked what further research is needed, Garant says real-world data with longer follow-up will be essential, since late radiation effects typically emerge at 2 years or beyond; her study cohort will reach that mark by year's end, and she hopes real-world evidence will reinforce the signal seen in the phase 1 data.

On referral pathways, Daniel Welchons, MD, says his practice treats spacing as standard for nearly every patient, noting that once patients understand the low risk and clear benefit, they often request it even when insurance coverage is uncertain. He describes bladder optimization and outlet procedures as an area with room to grow, and frames the shared goal as returning patients to where they were before treatment began, since curing the cancer is only part of the job if quality of life suffers.

Closing out the conversation, Welchons says the single change he'd want colleagues to make is reframing spacing and outlet procedures as preventive rather than reactive, addressing anatomy before treatment rather than managing complications afterward. He adds that hyaluronic acid spacing is a learnable, low-difficulty procedure that offers meaningful protection patients notice and appreciate.