- Design
- Multicentre, open-label, randomised phase 3 trial
- Population
- 505 men with high-risk prostate cancer on long-term ADT, France
- Primary outcome
- 5-year progression-free survival
- Effect
- 5-year 91.4% vs 88.1%; 10-year 83.6% vs 72.2%, HR 0.56 (95% CI 0.40–0.78)
GETUG AFU 18 randomised 505 men with high-risk prostate cancer (PSA 20 or above, Gleason 8 or above, or T3–T4) at 25 French centres to 80 Gy or 70 Gy of prostate radiotherapy, both with long-term androgen deprivation. Enrolment took place in 2009–2013, and median follow-up is 9.5 years.
At 5 years, progression-free survival was 91.4% against 88.1%. Because few events had occurred, 10-year results were added post hoc: 83.6% against 72.2% (HR 0.56). Acute and late grade 3 or worse toxicity were similar, with slightly more late bladder or urethral problems at 80 Gy.
Modern practice already uses dose-escalated or hypofractionated schedules for most patients, so this largely confirms that giving a full dose still matters when long-term ADT is added. It does not show a survival benefit, and 2 Gy fractions over 8 weeks are rarely used now.
- Ensure high-risk patients on long-term ADT receive a dose-escalated radiotherapy schedule
- Do not reduce radiotherapy dose because ADT is being given
- Monitor for late urinary toxicity
- Explain that cancer-specific and overall survival benefit have not been shown
Why it matters
It settles a long-standing doubt about whether radiotherapy dose still matters when long-term hormone therapy is given.
Don't overread it
The 10-year result was a post hoc analysis, and no survival benefit has been shown.
The statistics, in plain English
HR 0.56 (95% CI 0.40–0.78) is a 44% lower rate of progression over 10 years. But the 10-year analysis was added after the fact because 5-year events were too few, which makes it less secure than a prespecified result. Progression-free survival here includes PSA rises, which do not always lead to symptoms or death.
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