Commentary: Current Status of Prophylactic Nodal Irradiation in Ultra - Hypofractionated/ Stereotactic Body Radiotherapy for High - Risk Prostate Cancer

Ultra - hypofractionated radiation therapy, particularly Stereotactic Body Radiation Therapy (SBRT), has emerged as a promising treatment for localized prostate cancer. However, its role in high - risk prostate cancer, especially when combined with elective nodal irradiation (ENI), is still under investigation. This commentary explores the current evidence supporting the use of ultra - hypofractionated regimens and ENI in high - risk cases. While trials such as HYPO - RT - PC and PACE - B confirm the efficacy of SBRT in intermediate - risk prostate cancer, data on high - risk settings remain limited. Studies, including those by SHARP and Glicksman, highlight promising oncological outcomes with manageable toxicity profiles, though results also indicate variability in genitourinary (GU) and gastrointestinal (GI) toxicities. Ongoing trials like HOPE, SHARP, and PACE - NODE are anticipated to provide further clarity on toxicity and disease control with pelvic nodal irradiation. In conclusion, while SBRT with ENI shows potential, it cannot yet be considered the standard of care for high - risk prostate cancer until more robust, long - term evidence emerges.