Hypofractionated Postoperative Radiotherapy in Prostate Cancer: A Real-World Single-Center Experience.

BACKGROUND: Postoperative radiotherapy (RT) is an established treatment for biochemical recurrence (BR) after prostatectomy. Moderate hypofractionation offers potential radiobiological and logistical advantages, although evidence for non-escalated postoperative RT schedules remains limited. This study evaluated oncological outcomes in patients with a hypofractionated postoperative RT. METHODS: We retrospectively analyzed 189 patients with prostate cancer treated with postoperative hypofractionated RT to the prostate bed (55 Gy in 20 fractions). RT was delivered as salvage or adjuvant treatment according to pathological and biochemical findings. Survival outcomes and predictive factors were assessed using Kaplan-Meier and multivariable analyses. RESULTS: Most patients received salvage RT, with a median pre-RT prostate-specific antigen (PSA) of 0.61 ng/mL. High-risk pathological features were common, and 26.3% developed BR after treatment. 5-year disease-free survival reached 93.8%, while 5-year overall survival (OS) was 96.6%. Postsurgical grade, pre-RT PSA, nodal involvement, and androgen deprivation therapy (ADT) were associated with outcomes. CONCLUSIONS: Non-escalated hypofractionated postoperative RT yields favorable local disease control accompanied by acceptable safety toxicity profiles, supporting its application as an effective and practical alternative to conventional fractionation regimens. Further prospective clinical studies are needed to clarify the potential therapeutic role of dose escalation in routine postoperative treatment setting.