Has the HYDRA study of hypofractionated radiation, and its discussion in the 2026 NCCN guidelines for prostate cancer, changed your approach to moderate hypofractionation in either prostate-only or prostate and pelvic node radiation?

The meta-analysis suggested 60 in 20 was a similar dose (isodose) to conventional, so had similar BCR and morbidity while 70 in 28 was a higher dose, so had less BCR but also more morbidity. The OAR dose used in the RTOG hypofractionation study could have also contributed to high morbidity, and we ...

Very few of us can gain substantial wealth by giving 8 more fractions to prostate cancer. I certainly can't earn more by simply giving 28 or even 45 fractions or a 100 fx. The vast majority of us are now employed, and based on median RVU stats, a minority of us even reach a threshold to bonus or eve...

The short answer is...I have only used the 28-fx regimen for a brief period of time about 10 years ago, as the data for 20-fx rapidly surpassed and looked more favorable than the 28-fx regimen. So, I was already using the 20-fx regimen for 10+ years, and the NCCN guidelines reinforced this decision....