An American Society for Radiation Oncology clinical practice guideline, published in Practical Radiation Oncology on 27 October 2026, set out recommendations on hypofractionated external beam radiotherapy for localised prostate cancer, based on a systematic review and graded consensus.
Moderate hypofractionation is recommended over conventional fractionation for men receiving external beam radiotherapy in all risk groups, on the strength of high-quality randomised evidence showing equivalent cancer control, toxicity and quality of life with a shorter course. Ultrahypofractionation is recommended as a standard option for low- and intermediate-risk disease, and may be considered in selected high-risk patients, preferably within trials. The choice should not generally depend on age, comorbidity or androgen deprivation, but moderate schedules may be preferred where baseline urinary function is poor. Image guidance and conformal techniques are endorsed.
For patients, fewer visits mean less travel, time off work and cost — a material benefit wherever patients travel far to a radiotherapy centre. The guideline consolidates evidence that has accumulated over a decade rather than introducing a new finding.
- Offer moderate hypofractionation rather than conventional fractionation to men having external beam radiotherapy, across risk groups.
- Discuss ultrahypofractionation as a standard option for low- and intermediate-risk disease.
- Consider moderate rather than ultra-short schedules for men with significant urinary symptoms.
- Use image-guided, conformal techniques for hypofractionated courses.
- Factor travel distance and cost into the discussion; shorter courses reduce both.
Why it matters
It moves the shorter course from an acceptable option to the recommended default.
Don't overread it
A guideline consolidating existing trials; ultrahypofractionation in high-risk disease remains investigational.
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