Hypofractionated Radiotherapy for Localized Prostate Cancer

Patient Selection and Treatment Regimen

The National Comprehensive Cancer Network recommends hypofractionated radiotherapy with a dose of 60 Gy in 20 fractions over 4 weeks for patients with localized prostate cancer, using intensity-modulated radiotherapy (IMRT) with image-guided radiotherapy (IGRT) 1
For intermediate-risk disease, the National Comprehensive Cancer Network suggests considering 4-6 months of neoadjuvant/concurrent/adjuvant androgen deprivation therapy (ADT) and pelvic lymph node irradiation 1
For high-risk disease, the National Comprehensive Cancer Network recommends adding 2-3 years of ADT and including pelvic lymph node irradiation 1
For low-risk disease, active surveillance is considered first, but if radiotherapy is chosen, 60 Gy in 20 fractions without ADT or pelvic nodal irradiation is recommended 1, 3

Image-guided radiotherapy (IGRT) is essential when delivering hypofractionated doses, using CT, ultrasound with implanted fiducials, electromagnetic targeting/tracking, or endorectal balloon for daily prostate localization 1
The National Comprehensive Cancer Network recommends using 3D conformal or IMRT techniques to minimize toxicity while maintaining tumor control 1

The National Comprehensive Cancer Network recommends adding 4-6 months of androgen deprivation therapy for intermediate-risk disease and 2-3 years for high-risk disease 1, 2