GETUG-AFU 18 randomised 505 men with high-risk localised prostate cancer, all on long-term androgen deprivation, to 80 Gy versus 70 Gy of radiotherapy, and followed them for a median of 9.5 years — long enough to matter for a slow disease.
Dose escalation improved 10-year progression-free survival from 72.2% to 83.6% (stratified hazard ratio 0.56, 95% CI 0.40 to 0.78; p<0.0001). Acute and late grade 3 or worse toxicity were similar between arms (late grade 3+ 8% versus 7%), with no treatment-related deaths.
The practical message is that when high-risk patients are already committed to long-term hormone therapy, delivering the higher radiotherapy dose buys a durable progression benefit without a clear toxicity penalty. Prostate-cancer-specific and overall survival need longer follow-up given the low event numbers, so frame it as progression control rather than a survival guarantee.
- 80 Gy versus 70 Gy with long-term ADT in high-risk localised disease
- 10-year progression-free survival 83.6% vs 72.2% (HR 0.56)
- Late grade 3+ toxicity similar (8% vs 7%); no treatment-related deaths
- Overall survival not yet established — benefit is in progression control
The statistics, in plain English
A hazard ratio of 0.56 means dose-escalated patients had roughly 44% lower risk of progression or death over follow-up; the interval (0.40 to 0.78) is well below 1.0. The absolute gain — 83.6% versus 72.2% at 10 years — is the number to quote to a patient, because it states how many more remain progression-free, not just the relative risk.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for urology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free