GETUG AFU 18 randomised 505 men with high-risk prostate cancer on long-term androgen deprivation to 80 Gy or 70 Gy radiotherapy, and has now reported at a median 9.5 years.
At five years, progression-free survival was 91.4% with dose escalation and 88.1% with standard dose — a gap of three points. At ten years it was 83.6% against 72.2%, a stratified hazard ratio of 0.56 with an interval from 0.40 to 0.78. The benefit widened with time rather than eroding, which is the opposite of what most oncology trials show on extended follow-up.
Toxicity did not follow it upward. Acute grade 3 or worse events at six months were 24% against 25%. Late toxicity at five years was 70% against 73% overall, with grade 3 or worse at 8% against 7%. The most frequent late grade 3 event was bladder or urethral, seven cases against three. Serious adverse events were 4% in both arms and none were treatment related; there were no treatment-related deaths.
A trial enrolling from 2009 to 2013 reporting in 2026 is testing techniques that have since improved. That cuts both ways: modern conformal planning would likely reduce toxicity further, and the dose difference tested here is one that current practice has largely already adopted.
- The gap widened from 3 points at five years to 11 points at ten
- No increase in acute or late grade 3 toxicity with the higher dose
- All patients received long-term androgen deprivation — this is not radiotherapy alone
- Enrolled 2009 to 2013; planning and delivery have improved since
- Progression-free survival, not overall survival, remains the endpoint here
The statistics, in plain English
A hazard ratio of 0.56 with an interval from 0.40 to 0.78 is secure. The more instructive detail is how the absolute difference grew — three points at five years, eleven at ten. A hazard ratio assumes the relative effect is constant over time, so when a benefit accumulates like this, reporting five-year results alone would have understated it substantially.
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