In light of the recent data indicating increased late toxicities after hypofractionated salvage prostate radiation therapy, will you continue to offer it to patients?

Prior Literature: Prior non-randomized studies seem to suggest excess toxicity with hypofractionated PORT (e.g., Cozzarini et al., PMID 24985964, Tandberg et al., PMID 29559284). In part for this reason, a phase III, randomized controlled non-inferiority trial, NRG-GU003, was conducted (Buyyounouski...

This was not a randomized trial, so we cannot be sure of the impact of hypofractionation. But the increase in late grade ≥3 toxicity from 2 years to 13.5 years of median follow-up is dramatic and should give us pause. It is also a warning that we need very long-term toxicity outcomes data in more tr...

It does bring up the issue of longer follow-up for late effects, total dose delivered 65 Gy in 26 fractions (do we need such a high dose for BCR with no visible target?), and CTV delineation (RTOG atlas treats a lot more bladder than some recent recurrence patterns seen on PSMA).

Yes, but with the caveat that the choice between hypofractionated and conventionally fractionated salvage prostate radiation deserves a thoughtful discussion with the patient.

What we have learned from the ASTRO 2026 presentation is that, at five years, the patient-reported outcomes remain very simi...