Impact of Adaptive Radiation Therapy on Toxicity in Prostate Cancer: A Scoping Review

<b>Background/Objectives</b>: Existing literature reviews have not focused on the acute and late toxicities of non-magnetic resonance imaging (MRI)-guided adaptive radiation therapy (ART), compared the impacts of non-MRI-guided versus MRI-guided ART, or evaluated the effectiveness of adaptive conventional fractionated radiation therapy (CFRT) and stereotactic body radiation therapy (SBRT) in relation to toxicity in prostate cancer (PCa). The purpose of this scoping review was to systematically identify original articles and evaluate the impact of ART on toxicity in PCa in a comprehensive manner. <b>Methods</b>: A literature search was conducted using electronic databases on 17 June 2025, identifying 27 eligible papers. <b>Results</b>: The overall median toxicities of ART in PCa were 15.0% (acute grade 1 gastrointestinal (GI)), 1.0% (acute grade 2 GI), 0.0% (acute grade 3 GI), 47.1% (acute grade 1 genitourinary (GU)), 9.6% (acute grade 2 GU), 0.0% (acute grade 3 GU), 10.0% (late grade 1 GI), 2.0% (late grade 2 GI), 0.0% (late grade 3 GI), 29.7% (late grade 1 GU), 5.0% (late grade 2 GU), and 0.0% (late grade 3 GU). The choice of image guidance modality for ART does not appear to substantially influence toxicity; however, dedicated commercial ART systems may contribute to reducing toxicity to lower levels in PCa. Furthermore, the toxicity rates of adaptive CFRT and SBRT were comparable. <b>Conclusions</b>: Adaptive CFRT may be considered when SBRT is unsuitable for certain patients, without increasing the risk of side effects. However, further research is warranted to evaluate dedicated commercial cone-beam computed tomography (CT)- and CT-guided ART systems.