Prostate cancer (PCa) is the second most commonly diagnosed cancer worldwide. Radiotherapy remains one of the first-line treatments in localised disease and may be used as monotherapy or in combination with other treatments such as androgen deprivation therapy or radical prostatectomy. Despite advancements in delivery methods and techniques, radiotherapy has been unable to totally overcome radioresistance resulting in treatment failure or recurrence of previously treated PCa. Various factors have been linked to the development of tumour radioresistance including abnormal tumour vasculature, oxygen depletion, glucose and energy deprivation, changes in gene expression and proteome alterations. Understanding the biological mechanisms behind radioresistance is essential in the development of therapies that are able to produce both initial and sustained response to radiotherapy. This review will investigate the different biological mechanisms utilised by PCa tumours to drive radioresistance.

Introduction: Provision of education and training is essential when transitioning staff into specialist practice areas within pharmacy. While many professional organisations provide high-quality cancer/oncology education programs, they are non-specific to the policies, workflows, and resources of service providers. Furthermore, effective training and education programs can be a tool to increase staff engagement and retention. Our organisation developed a pharmacy Introduction to Cancer Care (ICC) program to address these needs. Method: The ICC program utilised online learning modules and a two-day face-to-face workshop. The program targeted pharmacists, intern pharmacists and pharmacy technicians new to cancer care and was facilitated by experienced pharmacists. Two evaluations were provided to participants, the first immediately post-program completion and the second, one-month post-program completion. The evaluations contained questions answered on a Likert Scale. Finally, staff retention rates were calculated at 6 months post-program. Results: Four sessions of the program were conducted between April 2023 and April 2024, with 24 pharmacists, six intern pharmacists and five technicians completing the program. Of the participants 89% (n = 31) provided responses to the evaluation on program completion and 31% (n = 9) to the evaluation at one-month post-program completion. Retention rates at six months post-program were found to be 100% for pharmacists (n = 24), intern pharmacists (n = 6) and technicians (n = 5). Conclusion: Evaluation responses were overwhelmingly positive, with all participants finding the program beneficial, increasing their interest in cancer care. Finally, all participants were still employed at the organisation six months post-program completion. Our program demonstrates ability of effective training and education programs to enhance staff learning and have positive impacts on engagement.

Background: Further work is needed to improve treatment outcomes for prostate cancer (PCa), with the repurposing of the α ₁ ‐adrenoreceptor antagonists presenting a potential solution. This feasibility clinical trial presents the first prospective data of the use of an α ₁ ‐adrenoreceptor antagonist in men undergoing radiotherapy for PCa. Methods: The study enrolled men planned to receive radiotherapy for PCa. Participants received escalating doses of prazosin administered during radiotherapy. Blood pressure was recorded at each radiotherapy fraction. The primary outcome was treatment protocol feasibility and secondary outcomes were maximum tolerated dose (MTD) of prazosin, safety, and progression‐free survival (PFS). Results: Ten participants were enrolled into the study and all achieved > 90% treatment compliance and > 80% assessment compliance. One participant and four participants achieved an MTD of 1 mg and 0.5 mg, respectively, and the remaining five participants had an MTD of 0 mg, with the overall protocol defined MTD being 0 mg. There were no Grades 3/4 adverse events. All treatment‐related adverse events (TRAE) were either hypotension or orthostatic hypotension, of the 17 reported TRAEs 16 were asymptomatic. No participants had evidence of disease progression at the 36‐week follow‐up. Conclusions: Our study demonstrated that coadministration of prazosin during radiotherapy is feasible. However, the incidence of hypotension resulted in a protocol‐defined MTD (under conservative blood pressure based DLT definition) of 0 mg, although 16 of the 17 reports were asymptomatic. Combined with monitoring used in other studies utilizing prazosin, this suggests that our safety monitoring and dose‐limiting toxicity (DLT) definition may have been too strict and did not accurately reflect a clinically relevant MTD. As this study achieved its primary aim and demonstrated the feasibility of the administration of prazosin during radiotherapy, further prospective studies are justified, with greater consideration given to the definition of DLTs. Trial Registration: Australian New Zealand Clinical Trials Registry (381954).