Who wants a Monday morning jolt via revisiting the now notorious IRRADIaTE study? This response points to high baseline comorbidity and older age—particularly in the radiation-only group—that likely confound hospitalization and toxicity outcomes, making it inappropriate to attribute findings to radiotherapy alone rather than recognizing potential contribution of underlying frailty. They also challenge the suggestion that postoperative radiation may be better tolerated than primary radiation, citing prospective trials and modern meta-analyses as much better means to understand comparative side effects. The authors respond it was never the intention of the registry to purport incidence across a population but rather to offer “a clinically relevant snapshot of severe radiation-related late GU toxicity requiring urgent care” … “driven by the perception that these events are sometimes overlooked by nonurological clinical physicians owing to their predominantly urological management and long latency after treatment.” Ultimately, it is wise both for radiation oncologists to recognize the limitations of our understanding of the finite risk of very late radiation toxicity as well as for the IRRADIaTE registry, with no clear denominator, to steer away from reporting percentages altogether. | Kishan & Vapiwala, Eur Urol Oncol 2026
