Hypofractionated Radiation Therapy for Localized Prostate Cancer: An ASTRO Clinical Practice Guideline
In brief
Shorter radiation schedules match conventional treatment for localized prostate cancer
The guideline recommends moderate hypofractionation over conventional radiation for all risk groups, with randomized evidence showing comparable cancer control, toxicity and quality of life in less treatment time. Very short schedules are a standard option for low- and intermediate-risk disease, but their role in high-risk cancer remains less certain; patients with significant urinary problems may be better suited to moderate schedules.
- Journal
- Practical radiation oncology (Q1)
- Published
- 27 October 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Scott C Morgan, Aditya Halthore, Angela Y Jia, Amar U Kishan, Andrew Loblaw, Xinglei Shen, et al.
- PMID
- 42946126
- DOI
- 10.1016/j.prro.2026.09.017
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 28 October 2026): Practice guideline on prostate radiotherapy fractionation and delivery
- Picked for Radiation Oncology (paper of the day, 28 October 2026): ASTRO guideline on hypofractionated EBRT for prostate cancer
Abstract
PURPOSE: This guideline provides evidence-based recommendations on the use of hypofractionated external beam radiation therapy (EBRT) in patients with localized prostate cancer, including indications for moderate hypofractionation (MHF) and ultrahypofractionation (UHF), appropriate dose-fractionation regimens, target volumes, and treatment planning and delivery techniques. METHODS: The American Society for Radiation Oncology convened a multidisciplinary task force to address 5 key questions related to hypofractionated EBRT in localized prostate cancer. Recommendations were based on a systematic literature review and developed using a predefined consensus-based methodology with grading of quality of evidence and strength of recommendation. RESULTS: MHF is recommended over conventional fractionation for patients receiving EBRT across all risk groups, supported by high-quality randomized data demonstrating equivalent oncologic outcomes, toxicity, and quality of life, with shorter treatment duration that may reduce overall treatment burden. UHF is recommended as a standard treatment option for patients with low- and intermediate-risk disease electing for definitive EBRT and may be considered in selected patients with high-risk disease, preferably in the context of clinical trials. Selection of fractionation should generally be independent of patient age, comorbidity, and use of androgen deprivation therapy, although MHF may be preferred over UHF for patients with significant baseline urinary dysfunction. Evidence supports the use of contemporary image-guided, conformal treatment techniques to optimize target coverage and minimize toxicity. Guidance is also provided regarding appropriate dose-fractionation regimens, including commonly used MHF and UHF schedules, as well as target volumes and integration of pelvic nodal irradiation. CONCLUSIONS: Hypofractionated EBRT has become the predominant form of definitive radiation therapy for localized prostate cancer, supported by mature randomized evidence demonstrating comparable outcomes to conventional fractionation and reduced treatment burden. Ongoing studies will further refine patient selection, the role of UHF in higher-risk disease, and integration of advanced imaging and adaptive technologies. These evidence-based recommendations inform best clinical practices in the use of hypofractionated EBRT for localized prostate cancer.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.