Take a mature look.

Definitive radiation using extreme hypofractionation, meaning a biologically-equivalent dose delivered over only something like 5 treatments, has become a popular treatment for lower risk prostate cancer over the past decade for obvious reasons. The biggest downside remains limited data on long-term toxicities. This meta-analysis pooled over 2100 men from early phase 2 trials to assess rates of biochemical control and late (>90 days) toxicity as captured prospectively. Rates of biochemical recurrence at 7 years were excellent: 5%, 9%, and 15% for low, favorable-, and unfavorable-intermediate risk disease, respectively. Cumulative rate of grade 3 GU toxicity at 7 years was only 2% and of GI toxicity was a measly 0.4% with only a single grade 4 GU and GI event each. TBL: We can’t say it better than the authors: “Our findings suggest that the major trepidation with [extreme hypofractionation to the prostate]—a risk of severe late toxic events—is not supported even with mature follow-up data.” | Kishan, JAMA Netw Open 2019