New guideline for early-stage prostate cancer supports use of shortened courses of radiation therapy
New recommendations reflect evidence showing similar early cancer control and side effect rates with hypo-fractionated treatment, compared to longer courses of conventional radiation.
Three prominent medical societies issued new clinical guideline for physicians treating men with early-stage prostate cancer using external beam radiation therapy (EBRT). Adoption of the guideline could make treatment shorter and more convenient for many patients with prostate cancer.
Developed by a panel of experts from the American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO) and American Urological Association (AUA), the new guideline recommends offering patients a treatment option known as hypo-fractionated radiation therapy as an alternative to longer, conventional courses of radiation. ASTRO, ASCO and AUA published the guideline in their respective journals, Practical Radiation Oncology, Journal of Clinical Oncology and The Journal of Urology.
“Conclusive evidence from several large, well-designed randomized trials now confirms that dose escalation can almost universally benefit men with early-stage prostate cancer who choose to manage their disease with external radiation,” said Howard Sandler, MD, FASTRO, FASCO, chair and professor of radiation oncology at Cedars-Sinai Medical Center and co-chair of the guideline panel. “Significant advances in treatment planning and delivery have enabled oncologists to deliver more powerful, life-saving doses of radiation in fewer visits and without compromising quality of life.”
External beam radiation therapy is a standard definitive treatment option that confers outcomes equivalent to radical prostatectomy for men with localized prostate cancer. When EBRT is hypo-fractionated, patients receive larger radiation doses across fewer treatment sessions—typically completing treatment in four to five weeks, compared with eight to nine weeks for conventional radiation.
Extremely hypo-fractionated courses, also known as ultra-hypofractionation, stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR), can be completed in as few as five treatments.
The recommendations apply to patients who require or prefer treatment instead of surveillance and have opted for EBRT instead of radical prostatectomy, brachytherapy or other treatment options for localized prostate cancer.