The American Society for Radiation Oncology has published a guideline on hypofractionated external beam radiotherapy for localised prostate cancer, developed by a multidisciplinary task force from a systematic review with graded evidence.
Moderate hypofractionation is recommended over conventional fractionation across all risk groups, based on high-quality randomised evidence of 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 in trials. The choice of fractionation should generally not depend on age, comorbidity or use of androgen deprivation, though moderate schedules may be preferred for men with significant baseline urinary symptoms. Image-guided, conformal techniques are supported.
For urologists, this matters at the counselling stage. A man choosing between surgery and radiotherapy may now be weighing a few weeks of treatment, or as few as five sessions, rather than eight weeks of daily visits. In India, where many patients travel far for radiotherapy, a shorter course can determine whether treatment is completed.
- Tell men considering radiotherapy that shorter, hypofractionated courses are now the recommended standard.
- Mention ultrahypofractionation as a standard option in low- and intermediate-risk disease.
- Flag significant baseline urinary symptoms to the oncologist, as moderate schedules may be preferred.
- Do not exclude older or comorbid men from hypofractionation on those grounds alone.
Why it matters
Fewer visits for the same cancer control changes how radiotherapy compares with surgery for many men.
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