Background: Modern radiotherapy techniques have improved the safety of prostate cancer treatment, but acute gastrointestinal and genitourinary toxicity remains a common clinical problem. Early identification of patients who are likely to develop treatment-related adverse effects may help optimize supportive care. This study evaluated the relationships between clinical characteristics, radiotherapy planning parameters, systemic inflammatory biomarkers, and acute pelvic toxicity during hypofractionated radiotherapy. Materials and Methods: We retrospectively analyzed 142 patients with histologically confirmed prostate cancer who underwent external beam radiotherapy at the Provincial Integrated Hospital in Płock, Poland, between October 2024 and March 2026. Clinical, laboratory, and radiotherapy planning data were obtained from institutional electronic records. Laboratory analyses included CRP, creatinine, total leukocyte, neutrophil, lymphocyte, erythrocyte and platelet counts, hemoglobin, and hematocrit. Rectal and bladder toxicity was prospectively graded according to the RTOG/EORTC criteria at 2 and 4 weeks after treatment initiation. Correlation and multivariable regression analyses were performed to identify factors associated with acute treatment-related toxicity. Results: Radiotherapy significantly reduced leukocyte and lymphocyte counts (both p < 0.001) and produced smaller reductions in erythrocyte count, hemoglobin, hematocrit, and absolute neutrophil count (all p < 0.05). Patients who reported rectal or urinary symptoms early during treatment generally continued to experience toxicity later in the treatment course. Rectal and bladder toxicities were positively correlated, indicating that patients with toxicity affecting one pelvic organ frequently developed symptoms in the other. Routine inflammatory biomarkers and most dosimetric parameters showed limited independent value for predicting clinically relevant acute toxicity. Conclusions: Early gastrointestinal and genitourinary toxicity appears to be a useful clinical indicator of persistent treatment-related symptoms during hypofractionated prostate radiotherapy. Early rectal and bladder toxicity was associated with toxicity later during treatment, whereas routine laboratory markers and most dosimetric parameters showed limited independent associations with acute pelvic toxicity.

Background and Objectives: Flank bulging is a recognized consequence of open renal surgery through a lumbotomy, but its clinical relevance and relationship with postoperative sensory changes are not well defined. We assessed the frequency and clinical burden of postoperative flank bulging, its overlap with sensory disturbances, and procedure-related factors associated with its occurrence. Materials and Methods: We reviewed 407 patients who underwent open renal surgery through a subcostal lumbotomy between 2018 and 2023. Flank bulging was the primary outcome. We also recorded scar hypoesthesia, wider areas of sensory loss, and whether patients found the resulting deformity bothersome. Factors associated with bulging were explored using multivariable logistic regression, with a separate analysis comparing nephron-sparing surgery (NSS) and radical nephrectomy. Results: Flank bulging was found in 88 patients (21.6%). Scar hypoesthesia occurred in 14.0% and more extensive sensory loss in 7.1%. Sensory abnormalities showed a strongly nested clinical pattern: all patients with scar hypoesthesia had flank bulging, and all extended sensory deficits occurred among patients with both bulging and scar hypoesthesia. All patients with scar hypoesthesia also had bulging, while wider sensory loss was seen only when both were present. Among patients for whom this information was available, 52.9% described the bulging as bothersome. It was more common after NSS than after radical nephrectomy (27.0% vs. 16.3%). The difference persisted after adjustment for age and sex (aOR 2.05, 95% CI 1.17–3.59), corresponding to an adjusted absolute risk difference of 11.8 percentage points (95% CI 2.4–20.8). Conclusions: About one in five patients developed flank bulging after open renal surgery through a lumbotomy, and many of those affected found it bothersome. The accompanying sensory changes raise the possibility that nerve injury contributes to this complication, although our data cannot establish the underlying mechanism. The higher rate observed after NSS compared with radical nephrectomy also warrants further study. Prospective assessment with standardized imaging and more detailed operative data may help explain these findings and identify factors that could reduce the risk of postoperative bulging.