This is a randomised phase 3 trial of 505 men with high-risk prostate cancer, assigned to 80 Gy or 70 Gy radiotherapy, both with long-term androgen deprivation. Recruitment ran from 2009 to 2013 and the median follow-up is now 9.5 years, which is what makes this report worth reading rather than the original.
At five years, progression-free survival was 91.4% against 88.1% — a gap of about three points. At ten years it was 83.6% against 72.2%, a gap of eleven, with a hazard ratio of 0.56. The benefit did not appear late; it widened.
Toxicity did not follow the same curve. Acute grade 3 or worse events at six months were 24% against 25%. Late grade 3 or worse events at five years were 8% against 7%. Serious adverse events were 4% in both arms and there were no treatment-related deaths. The main late grade 3 problem was bladder or urethral, at 4% against 2%.
The authors are careful about what remains unproven: event numbers are low and neither prostate-cancer-specific nor overall survival is established. But for a patient choosing a radiotherapy dose today, a widening progression benefit with flat late toxicity across a decade is a strong argument, and ten-year data on this question have been scarce.
- Quote the ten-year figures, not the five-year ones: the difference is 11 points, not 3.
- Late grade 3 toxicity was 8% against 7% — dose escalation did not buy the benefit with late harm here.
- Bladder and urethral toxicity is the late problem to counsel about, at 4% against 2%.
- Survival benefit is not established; this is progression-free survival.
- Both arms had long-term ADT, so this is a dose question, not a question about ADT.
The statistics, in plain English
A hazard ratio of 0.56 with an interval of 0.40 to 0.78 means the rate of progression was roughly halved, and the interval is comfortably clear of 1.0. The more informative comparison is the shape over time: a three-point gap at five years becoming eleven at ten shows the curves diverging rather than an early separation that then holds. Long follow-up is what makes that visible, and it is why a 2009-2013 trial is news in 2026. The authors' own caution is about event counts — progression-free survival accumulates events faster than death does, so the trial can be well powered for the first and underpowered for the second. Nothing here establishes that men live longer.
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