The 2025 Annual Meeting of the American Society for Radiation Oncology (ASTRO) brought together experts from around the world to share the latest research and innovations in cancer care. For prostate cancer, this year’s meeting highlighted advances in treatment approaches, precision therapies, and strategies to improve patient outcomes. We’ve summarized some of the top takeaways below.

1) AI contouring for prostate brachytherapy: Patient outcomes unchanged despite differences

A new study found that even though artificial intelligence (AI) software creates different outlines of CT scans compared to doctors after prostate brachytherapy, these differences don’t seem to affect patient outcomes. Researchers compared AI-generated contours with those drawn by physicians for 100 patients and found no significant differences in important outcomes like cancer recurrence or survival, suggesting that focusing on patient results rather than the exact contour lines is most important when evaluating these new technologies. While more research is needed, this could mean that AI tools could help save time for doctors in the future.

2) Shorter radiation therapy for prostate cancer reduces side effects but not disease control

For patients with intermediate-risk, localized prostate cancer, a new study shows that radiation therapy delivered in just five sessions (called SBRT) led to fewer patient-reported side effects compared to longer courses of radiation. Patients who received SBRT reported fewer declines in bowel, urinary, and sexual functioning. While these patients were more likely to experience a rise in a marker called PSA, researchers noted that these elevations can sometimes be temporary and require longer follow-up to determine if they indicate actual disease progression. 

This means patients now have clearer information to help them decide between a more convenient treatment with better quality of life or a longer therapy that might offer stronger biochemical cancer control, depending on their personal priorities.

3) Personalized treatment for recurrent prostate cancer

A new study has found a groundbreaking lab test that can look at the genes within a prostate tumor to predict which patients with recurrent prostate cancer will benefit most from adding hormone therapy to radiation after surgery. This is the first time such a predictive tool has been validated, allowing doctors to tailor treatment based on a tumor’s unique biology. Patients with a specific tumor type called luminal B saw a significant reduction in cancer recurrence and spread when hormone therapy (apalutamide) was combined with radiation. 

However, patients without this tumor type did not experience the same benefits, suggesting that hormone therapy might not be necessary for them, thus avoiding potential side effects. This advancement means that treatment can be personalized, ensuring that patients receive hormone therapy only if it is likely to help them.

4) New treatment delays progression for recurrent prostate cancer

A new clinical trial, LUNAR, has found that people with a limited number of recurring prostate cancer metastases lived significantly longer without their disease progressing when they received an experimental radiopharmaceutical drug (77Lu-PNT2002, which targets prostate specific membrane antigen (PSMA)) before targeted radiation, compared with radiation alone. 

This is the first randomized study to show that a treatment typically used for later-stage prostate cancer can delay progression and the need for hormone therapy when added to high-precision radiation therapy for patients with early metastatic disease. This approach helps target both visible and microscopic cancer cells, offering a meaningful quality-of-life improvement by safely delaying hormone therapy, which can have significant side effects.

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