ASTRO now recommends moderate hypofractionation over conventional radiotherapy for localised prostate cancer

The edition in brief

Today's urology edition ends on a guideline that shortens prostate radiotherapy. The American Society for Radiation Oncology recommends moderate hypofractionation over conventional fractionation for localised prostate cancer in all risk groups, on high-quality randomised evidence of equivalent cancer control, toxicity and quality of life with fewer visits. Ultrahypofractionation is a standard option for low- and intermediate-risk disease and may be considered in selected high-risk patients, preferably in trials; moderate schedules may be preferred where baseline urinary function is poor. In the phase 2 PSMAgRT trial of 253 men, intensifying radiotherapy to all PSMA-PET-detected disease did not significantly improve 5-year failure-free survival (66% vs 62%), though biochemical control favoured it, particularly in high-risk and post-prostatectomy strata. A Bayesian meta-analysis of 938 men found each extra millimetre of membranous urethral length on postoperative MRI was associated with higher odds of continence after robotic prostatectomy, with low certainty. A prospective Australian study of 691 patients with haematuria found a commercial urine biomarker test had 89% sensitivity and 99% negative predictive value against cystoscopy, missing six tumours, five of them low-grade. The pearl covers which haematuria still needs cystoscopy.