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?

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 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 ...

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....

The authors of the HYDRA study should be commended for their work. To my knowledge, however, there is no good phase 3 study that compares 60 Gy/20 to 70 Gy/28. Inter-trial comparisons of control and toxicity are fraught with potential error and are probably just another form of "phase 2ism" (IMAO). ...

SBRT.

When I look at 'late side effects' and the excellent discussion earlier, a couple of points are:

1. The realization that most of my patients today with prostate cancer are healthy and likely to live beyond ten years otherwise (this is within my practice and may not be the same for others);
2. It does take...