Daily imaging during prostate cancer radiotherapy could help doctors adjust treatment and reduce side effects, according to new research.
A team at the University of Edinburgh used artificial intelligence to analyze scans taken to position patients for treatment. They found that these scans also revealed changes linked to later rectal bleeding as early as one week into therapy.
“Early treatment imaging contains quantitative information about later toxicity risk, long before symptoms occur,” said Dr. Zhuolin Yang, research fellow at the University of Edinburgh’s Institute of Genetics and Cancer. “This suggests that predictive biomarkers for adaptive radiotherapy may not require new scans or technology—just better use of existing data.”
Radiotherapy is effective for prostate cancer but can damage nearby healthy tissue, such as the rectum, because of its proximity to the prostate.
The study analyzed daily imaging from 187 patients and used machine learning to identify patterns in tissue, known as radiomic features, that were linked to rectal bleeding within two years. Patterns seen on a single scan one week into treatment were highly predictive, while combining data from the first three weeks gave the most reliable results.
Researchers say the approach could eventually be integrated into routine treatment planning to guide when and how therapy should be adapted. However, they caution that larger studies and further validation are needed before it can be widely implemented.
“This study provides proof-of-concept that imaging collected for beam setup could support future adaptive workflows,” said Professor Bill Nailon, clinical scientist at Edinburgh Cancer Centre. “Future trials and automation will be essential before such approaches can inform clinical decision-making.”
Dr. Hayley Luxton, head of research impact at Prostate Cancer UK, which funded the study, added: “Radiotherapy is a common and effective treatment for prostate cancer. But movement of the prostate and surrounding organs during therapy can lead to side effects like bleeding, which significantly affect men’s lives.
“While more research is needed in larger patient groups, this study is an important step toward personalising radiotherapy to make it safer and more effective.”
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