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ASTRO's updated guideline now recommends moderate hypofractionation over conventional radiation for all risk groups with localized prostate cancer. It also elevates 5-fraction SBRT (ultrahypofractionation) to a standard treatment option for many patients. The update, replacing 2018 guidance, is backed by long-term data from 11 randomized trials involving over 7,000 patients.
The American Society for Radiation Oncology (ASTRO) has released an updated clinical practice guideline recommending moderate hypofractionation as the preferred approach over conventional fractionation for all risk groups with localized prostate cancer undergoing external beam radiation therapy (EBRT). The guideline, published in Practical Radiation Oncology, replaces ASTRO's 2018 recommendations and reflects a significant shift in how radiation is delivered.
Ultrahypofractionation — most commonly delivered as stereotactic body radiation therapy (SBRT) in just 5 sessions over 1–2 weeks — is now recognized as a standard treatment option for patients with low- and intermediate-risk disease, and conditionally recommended for high-risk cases. Patients with significant baseline urinary symptoms are an exception, where moderate hypofractionation is preferred due to a higher risk of urinary side effects with larger fraction sizes.
Key Takeaways:
Why it matters: Shorter treatment courses mean less time in the clinic for patients — without sacrificing outcomes. With 11 randomized trials and 7,000+ patients backing these recommendations, clinicians now have strong, evidence-based guidance to offer more convenient and equally effective radiation schedules.
