Prostate cancer is one of the most prevalent malignancies in men, posing a significant public health challenge due to its high incidence and long-term treatment-related toxicities. Long-lived patients often experience prolonged side effects that can severely diminish their quality of life. Despite advancements in radiotherapy techniques like IMRT and VMAT, some patients still experience acute and late side effects. Current treatment protocols do not account for individual variability in normal-tissue radiosensitivity, highlighting the need for predictive tools and a personalised treatment approach. Genetic factors and molecular regulators like microRNAs (miRNAs) contribute to these variations by influencing DNA repair, inflammation, and apoptosis. This review explores potential biomarkers of radiotoxicity, focusing on immune-related factors such as IL-6 and TGF-β1, SNPs influencing radiosensitivity, miRNAs involved in radiation responses, and functional assays including the radiation-induced lymphocyte apoptosis (RILA) test. These approaches offer promising tools for identifying radiosensitive patients and enabling risk-adapted radiotherapy.

Prostate cancer (PC) is the most frequent male tumor, accounting for about one-third of all cancers in men. Since survival is often favorable regardless of therapy, treatment decisions may depend on therapy-specific health outcomes. The majority of men initially diagnosed with localized PC ultimately die with, rather than of, their disease. As a result, men who are diagnosed will live many years with the treatment's sequelae. The major therapeutic strategies include radical prostatectomy or external beam radiotherapy. Radiotherapy is one of the curative treatment options. The tumor dose-response relationship has been studied and is widely accepted. The unsatisfactory local control with doses < 70 Gy led to dose escalation using highly precise radiotherapy techniques - three-dimensional conformal radiotherapy and intensity-modulated radiotherapy enabling the delivery of high radiation doses up to 74 - 78 Gy. Bowel, rectal and urinary toxicities are the principal limiting factors in delivering a high dose. Acute symptoms include a change in bowel habits, urgency, and fecal incontinence. The most commonly reported late toxicities were chronic diarrhea, proctitis, or rectal bleeding. Several factors have been associated with increased gastrointestinal toxicity such as larger bowel volume receiving high doses, the patient's age, diabetes, and concomitant use of androgen deprivation therapy. Bladder damage resulting from acute radiation toxicity is manifested as radiation cystitis (frequent urination and dysuric disorders). Smoking, previous abdominopelvic surgeries and the use of diuretics significantly affect the occurrence of acute genitourinary toxicity grade ≥ 2. Risk factors for the development of late genitourinary complications are higher radiation dose, previous urinary problems, transurethral interventions, and acute genitourinary complications. It is essential to strike a balance between the therapeutic benefits and radiotherapy side effects. Severe late complications significantly reduce the quality of life (QOL) of PC survivors. Early detection and proper evaluation of complications are especially important in increasing the patient's QOL.

Prostate cancer (PC) is one of the most prevalent cancers in men and the second leading cause of cancerrelated deaths, after lung cancer. The incidence and mortality from PC worldwide are correlated with increasing age. The treatment of patients is multidisciplinary, with radiotherapy being an integral part, whether applied as an independent method or in combination with surgery or systemic therapy. The technological progress in the middle of the last century, opened up new possibilities in the planning and conducting radiotherapy started the new era of radiotherapy called modern radiotherapy. Today, highly conformal external beam techniques such as intensity-modulated radiotherapy (IMRT) and volume-modulated arc therapy (VMAT) are used as the gold standard in PC radiotherapy. They enable the precise definition of tumor volume based on modern diagnostic procedures, with maximum sparing of the surrounding organs. Advanced conformal techniques have also led to an escalation of the tumor dose, thus achieving better local control of the disease with significant reduction of early and late complications of treatment, the quality of life of PC patients is preserved. In addition to technological progress, modern radiotherapy includes monitoring the side effects of radiotherapy, and assessment of clinical and individual parameters that affect sensitivity and response to radiation. This should enable personalized radiotherapy with optimization of the treatment for each patient, which is one of the goals of modern oncology.

Oligometastatic disease is defined as an intermediate state between localized and widespread metastatic disease. Oligometastatic prostate cancer is generally defined by the presence of five or fewer metastatic sites on imaging. In the era of precision and personalized cancer care, the introduction of more sensitive imaging technologies and the availability of safe and effective localized non-or minimally invasive treatment options, have led to an increase in the incidence and clinical interest in oligometastatic prostate cancer. In addition, the therapeutic paradigm for oligometastatic prostate cancer is evolving toward a more aggressive approach. Retrospective studies have shown that in the metastatic setting, treatments such as radical prostatectomy and local or metastasis-directed radiation therapy can be performed with minimal risk of toxicity and may enhance clinical outcomes. As there is insufficient data to draw reliable conclusions about their impact on survival, aggressive approaches in the treatment of oligometastatic prostate cancer should be considered only in the context of prospective clinical trials, with the patient informed of the limited evidence of benefit. The current inconsistent approach of detecting and treating oligometastatic prostate cancer patients will need to be standardized in order for future clinical studies to be properly performed and, more importantly, compared. These crucial conditions will reveal if oligometastasis diagnosis and therapy should be included in the standard clinical practice of prostate cancer patients.

Introduction: Pancreatic metastases from anal canal squamous cell carcinoma (SCC) are exceptionally rare. To date, only one previous case has been reported. The present case represents the second documented instance, highlighting the unusual metastatic pattern and the challenges in diagnosis and treatment. Due to the rarity of such metastases, their clinical presentation and optimal management remain poorly understood. Case presentation: We describe a 64-year-old woman diagnosed with locally advanced anal canal SCC, with diagnosis delayed as she had deferred medical consultation, who then received definitive chemoradiotherapy. During routine follow-up imaging, a small pancreatic lesion was initially overlooked and not reported. One and a half years later, the patient presented with nonspecific abdominal symptoms, and imaging revealed a 5 cm pancreatic mass. Endoscopic ultrasound-guided biopsy confirmed metastatic SCC of anal origin. The mass was considered inoperable due to vascular invasion. Systemic chemotherapy induced partial remission; however, due to hematologic toxicity, treatment was modified, and stereotactic body radiotherapy was applied to the pancreatic lesion, resulting in disease stabilization. Subsequent pulmonary metastases were treated with second-line chemotherapy, resulting in further partial remission; however, later disease progression was observed, limited to the pancreas, and third-line chemotherapy was planned but not initiated due to deterioration of general condition. Conclusion: This case highlights the importance of vigilant long-term surveillance and multidisciplinary management in patients with anal SCC, especially when atypical metastatic sites like the pancreas are involved. Early identification and histopathological confirmation enable timely, targeted treatment, which can improve clinical outcomes in such rare presentations.

Background: Organized cervical cancer screening aims to reduce the burden of advanced disease through earlier detection. However, a substantial proportion of women continue to present with locally advanced cervical cancer (LACC) requiring definitive chemoradiation. This study evaluated temporal changes in the demographic and clinicopathological characteristics of women with LACC treated with definitive chemoradiation before and after implementation of the organized cervical cancer screening program in Serbia. Methods: This retrospective single-center cohort study included 200 consecutive women with histologically confirmed LACC treated with definitive chemoradiation at the Institute of Oncology and Radiology of Serbia. Two cohorts were analyzed: a pre-screening cohort (2010–2011, n = 100) and a post-screening cohort (2022–2023, n = 100). Demographic and clinicopathological characteristics, including age, histopathology, FIGO stage, lymph node involvement, and geographic distribution, were compared. For study purposes, all patients were retrospectively restaged according to the FIGO 2018 classification using the best available clinical, radiological, and pathological data. Results: Women in the post-screening cohort were significantly older at diagnosis than those in the pre-screening cohort (mean age 54.9 vs. 49.7 years, p = 0.0046), with a substantially higher proportion of patients older than 64 years (28% vs. 2%, p < 0.0001). Although the overall distribution of FIGO stages II–IV did not differ significantly, a marked redistribution of FIGO 2018 substages was observed (p < 0.0001), characterized by an increased proportion of stage IIIC disease and significantly more frequent lymph node involvement (63% vs. 41%, p = 0.0018). Geographic distribution remained stable, with most patients referred from the Belgrade administrative district. Conclusions: This study demonstrated clinically relevant temporal changes in the demographic and clinicopathological characteristics of women requiring definitive chemoradiation for LACC in Serbia. More than a decade after implementation of organized cervical cancer screening, tertiary referral centers continue to manage a substantial burden of patients with locally advanced disease requiring complex, resource-intensive treatment. These findings should not be interpreted as a direct evaluation of the national screening program but may provide valuable insights for healthcare planning in Serbia and other countries with similarly resource-constrained healthcare systems. Strengthening participation in organized screening, ensuring timely diagnostic evaluation, and improving HPV vaccination uptake remain essential to reduce the burden of advanced cervical cancer.