Guideline on shorter-course radiation therapy for localized prostate cancer updated

The American Society for Radiation Oncology (ASTRO) has released an updated clinical guideline on hypofractionated radiation therapy for localized prostate cancer. This replaces the 2018 recommendations and is based on a more mature evidence base showing that shorter-course radiation therapy can maintain cancer control while reducing treatment burden for patients. Over 334,000 new cases of prostate cancer are expected to be diagnosed among U.S. adults in 2026.

For patients with localized prostate cancer who choose radiation therapy, conventional external beam radiation therapy (EBRT) is a standard option. Hypofractionated EBRT delivers radiation therapy in fewer sessions, using a higher dose per treatment. Moderate hypofractionation, delivered over 4-6 weeks, is now recommended over conventional fractionation for all prostate cancer risk groups, supported by high-quality randomized data.

Ultrahypofractionation, or stereotactic body radiation therapy (SBRT), which allows patients to complete treatment in 5 sessions over 1-2 weeks, is also strongly recommended as a standard option for many patients, including those with intermediate-risk disease. This marks a broader role for SBRT in prostate cancer care.

Guideline task force chair Dr. Scott C. Morgan emphasized that these recommendations give clinicians clear direction on using shorter-course treatment safely while preserving excellent outcomes. ASTRO task force vice chair Dr. Karen Hoffman noted that the evidence supporting hypofractionation is stronger now than when the previous guideline was published.

The guideline also emphasizes the importance of shared decision-making between physicians and patients, considering factors like risk group, urinary function, and patient preferences. Implementation and equity considerations are also highlighted, as use of hypofractionated EBRT varies by age, race, socioeconomic factors, and treatment setting.