Daily scans during prostate cancer radiotherapy could guide changes to treatment to cut side effects, a recent study suggests.
Using AI, scientists found that scans taken to position patients for treatment also flagged changes linked to later rectal bleeding as early as one week into therapy.
Monitoring these early changes could help doctors decide when to adapt treatment while maintaining cancer control, according to University of Edinburgh researchers.
Dr Zhuolin Yang, research fellow from the University of Edinburgh’s Institute of Genetics and Cancer, said: “The key result here is that early treatment imaging contains quantitative information about later toxicity risk, long before symptoms occur.
“This supports the idea that predictive biomarkers for adaptive radiotherapy may not require new scans or technology, only better use of the data we already collect.”
Radiotherapy is effective but can cause side effects when nearby healthy tissue, such as the rectum, receives some radiation because of its proximity to the prostate.
The team examined daily imaging from 187 patients treated with prostate radiotherapy, using machine learning to link patterns in the tissue, known as radiomic features (quantitative image patterns), to rectal bleeding within two years.
Patterns seen on single scans one week into treatment were highly predictive of later rectal bleeding. Combining data from the first three weeks gave the most reliable prediction.
The researchers say the approach could one day be built into routine planning and monitoring to guide when and how to adjust treatment, but caution that this will take years and needs confirmation in larger studies.
Professor Bill Nailon, clinical scientist at Edinburgh Cancer Centre, said: “This study gives a proof-of-concept that imaging collected for beam setup could support future adaptive workflows.
“Future trials and automation will be essential before approaches like this can be integrated into clinical decision-making.”
Dr Hayley Luxton, head of research impact at Prostate Cancer UK, which funded the study, added: “Radiotherapy is a very common treatment used to cure prostate cancer.
“While very effective, the natural movement of the prostate and surrounding organs during treatment can lead to damage to the surrounding areas, causing bleeding and other side effects that can have a significant impact on men’s lives.
“While more research is needed in larger groups of men, this marks a great step forward in personalising radiotherapy to make it kinder and better for more men who need it.”
