Peri-urethral calcifications as a potential biomarker for acute genitourinary toxicity following prostate stereotactic body radiotherapy
4 affiliations
- 1Department of Radiology, Ziv Medical Center, Safad, Israel
- 2Department of Radiotherapy, Ziv Medical Center, Safad, Israel
- 3Department of Medical Oncology, Ziv Medical Center, Safad, Israel
- 4Department of Urology, Ziv Medical Center, Safad, Israel
Abstract
Background and objectives
Peri-urethral calcifications (PUCs) are readily identifiable on planning computed tomography (CT) and may reflect chronic inflammation, fibrosis, and reduced peri-urethral tissue compliance. We evaluated whether baseline PUCs are associated with acute genitourinary (GU) toxicity following prostate stereotactic body radiotherapy (SBRT).Methods
We retrospectively analyzed 60 consecutive patients with localized prostate adenocarcinoma treated with definitive SBRT between June 2023 and February 2026. PUCs were assessed on non-contrast planning CT using predefined criteria by blinded observers. The primary endpoint was acute grade ≥ 2 GU toxicity occurring during treatment or within 90 days, graded according to CTCAE v5. Associations with toxicity were evaluated using logistic regression, with Firth penalized regression used for multivariable analysis.Results
PUCs were identified in 17 patients (28.3%). Interobserver agreement was high (93.3%; Cohen's κ = 0.84). Overall, 21 patients (35%) developed acute grade ≥ 2 GU toxicity, including three (5%) with grade ≥ 3 toxicity. Acute grade ≥ 2 GU toxicity occurred significantly more frequently in patients with PUCs than in those without PUCs (64.7% vs 23.3%; OR 6.05, 95% CI 1.78-20.51; P = 0.006). After adjustment for baseline International Prostate Symptom Score (IPSS), PUCs remained independently associated with toxicity (adjusted OR 6.90, 95% CI 1.97-27.96; P = 0.002). Baseline IPSS was also independently associated with toxicity (adjusted OR 1.13 per point; P = 0.008).Conclusion
PUCs on routine planning CT were independently associated with acute grade ≥ 2 GU toxicity after prostate SBRT. If externally validated, PUC assessment may provide a simple, cost-neutral imaging biomarker for pretreatment urinary toxicity risk stratification.
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BibTeX
@article{awad2026periurethral,
title = {{Peri-urethral calcifications as a potential biomarker for acute genitourinary toxicity following prostate stereotactic body radiotherapy}},
author = {Moanes Awad and Ismaell Massalha and Yonina Tova and Jamal Zidan and Ran Katz and Adham Hijab},
journal = {Clinical and translational radiation oncology},
year = {2026},
month = oct,
doi = {10.1016/j.ctro.2026.101311},
url = {https://europepmc.org/article/PMC/PMC13716953},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Peri-urethral calcifications as a potential biomarker for acute genitourinary toxicity following prostate stereotactic body radiotherapy
AU - Moanes Awad
AU - Ismaell Massalha
AU - Yonina Tova
AU - Jamal Zidan
AU - Ran Katz
AU - Adham Hijab
PY - 2026
DA - 2026/10/15
JO - Clinical and translational radiation oncology
DO - 10.1016/j.ctro.2026.101311
UR - https://europepmc.org/article/PMC/PMC13716953
AB - Background and objectives Peri-urethral calcifications (PUCs) are readily identifiable on planning computed tomography (CT) and may reflect chronic inflammation, fibrosis, and reduced peri-urethral tissue compliance. We evaluated whether baseline PUCs are associated with acute genitourinary (GU) toxicity following prostate stereotactic body radiotherapy (SBRT).Methods We retrospectively analyzed 60 consecutive patients with localized prostate adenocarcinoma treated with definitive SBRT between June 2023 and February 2026. PUCs were assessed on non-contrast planning CT using predefined criteria by blinded observers. The primary endpoint was acute grade ≥ 2 GU toxicity occurring during treatment or within 90 days, graded according to CTCAE v5. Associations with toxicity were evaluated using logistic regression, with Firth penalized regression used for multivariable analysis.Results PUCs were identified in 17 patients (28.3%). Interobserver agreement was high (93.3%; Cohen's κ = 0.84). Overall, 21 patients (35%) developed acute grade ≥ 2 GU toxicity, including three (5%) with grade ≥ 3 toxicity. Acute grade ≥ 2 GU toxicity occurred significantly more frequently in patients with PUCs than in those without PUCs (64.7% vs 23.3%; OR 6.05, 95% CI 1.78-20.51; P = 0.006). After adjustment for baseline International Prostate Symptom Score (IPSS), PUCs remained independently associated with toxicity (adjusted OR 6.90, 95% CI 1.97-27.96; P = 0.002). Baseline IPSS was also independently associated with toxicity (adjusted OR 1.13 per point; P = 0.008).Conclusion PUCs on routine planning CT were independently associated with acute grade ≥ 2 GU toxicity after prostate SBRT. If externally validated, PUC assessment may provide a simple, cost-neutral imaging biomarker for pretreatment urinary toxicity risk stratification.
SN - 2405-6308
ER -