Moderate hypofractionation is safe and effective , but longer-term data are still lacking .
Brachytherapy represents an effective way to increase the delivered dose .
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology ( EAU ) - European Society for Radiotherapy & Oncology ( ESTRO ) - International Society of Geriatric Oncology ( SIOG ) Guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly localised prostate cancer ( PCa ) .
EVIDENCE SYNTHESIS BRCA2 mutations have been added as risk factors for early and aggressive disease .
Systematic screening is still not recommended .
An early prostate-specific antigen test , the use of a risk calculator , or one of the promising biomarker tools are being investigated and might be able to limit the overdetection of insignificant PCa .
Breaking the link between diagnosis and treatment may lower the overtreatment risk .
Multiparametric magnetic resonance imaging using st and ardised reporting can not replace systematic biopsy , but robustly nested within the diagnostic work-up , it has a key role in local staging .
In Northern and Western Europe , the number of men diagnosed with PCa has been on the rise .
Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): final efficacy results from a randomised, multicentre, open-label, phase 3 trial.
BACKGROUND Studies have reported a low α/β ratio for prostate cancer , suggesting that hypofractionation could enhance the biological tumour dose without increasing genitourinary and gastrointestinal toxicity . In the multicentre phase 3 , HYpofractionated irradiation for PROstate cancer ( HYPRO ) trial , hypofractionated radiotherapy was compared with conventionally fractionated radiotherapy for treatment of prostate cancer . We have previously reported acute and late incidence of genitourinary and gastrointestinal toxicity ; here we report protocol -defined 5-year relapse-free survival outcomes . METHODS We did an open-label , r and omised , phase 3 trial at seven Dutch radiotherapy centres . We enrolled patients with intermediate-risk to high-risk T1b-T4NX-N0MX-M0 localised prostate cancer , a prostate-specific antigen concentration of 60 μg/L or less , and a WHO performance status of 0 - 2 . We used a web-based application to r and omly assign ( 1:1 ) patients to either hypofractionated radiotherapy of 64·6 Gy ( 19 fractions of 3·4 Gy , three fractions per week ) or conventionally fractionated radiotherapy of 78·0 Gy ( 39 fractions of 2·0 Gy , five fractions per week ) . Based on an estimated α/β ratio for prostate cancer of 1·5 Gy , the equivalent total dose in fractions of 2·0 Gy was 90·4 Gy for hypofractionation compared with 78·0 Gy for conventional fractionation . The primary endpoint was relapse-free survival . All analyses were done on an intention-to-treat basis in all eligible patients . The HYPRO trial completed recruitment in 2010 and follow-up is ongoing . This trial is registered with IS RCT N , number IS RCT N85138529 . FINDINGS Between March 19 , 2007 , and Dec 3 , 2010 , 820 patients were enrolled , of whom 804 were eligible and assessable for intention-to-treat analyses . Of these , 407 were assigned hypofractionated radiotherapy and 397 were allocated conventionally fractionated radiotherapy . 537 ( 67 % ) of 804 patients received concomitant and rogen deprivation therapy for a median duration of 32 months ( IQR 10 - 44 ) . Median follow-up was 60 months ( IQR 51 - 69 ) . Treatment failure was reported in 169 ( 21 % ) of 804 patients , 80 ( 20 % ) in the hypofractionation group and 89 ( 22 % ) in the conventional fractionation group . 5-year relapse-free survival was 80·5 % ( 95 % CI 75·7 - 84·4 ) for patients assigned hypofractionation and 77·1 % ( 71·9 - 81·5 ) for those allocated conventional fractionation ( adjusted hazard radio 0·86 , 95 % CI 0·63 - 1·16 ; log-rank p=0·36 ) . There were no treatment-related deaths . INTERPRETATION Hypofractionated radiotherapy was not superior  to conventional radiotherapy with respect to 5-year relapse-free survival . Our hypofractionated radiotherapy regimen can not be regarded as the new st and ard of care for patients with intermediate-risk or high-risk prostate cancer . FUNDING Dutch Cancer Society
Moderate hypofractionation is safe and effective , but longer-term data are still lacking .
Brachytherapy represents an effective way to increase the delivered dose .
OBJECTIVE To present a summary of the 2016 version of the European Association of Urology ( EAU ) - European Society for Radiotherapy & Oncology ( ESTRO ) - International Society of Geriatric Oncology ( SIOG ) Guidelines on screening , diagnosis , and local treatment with curative intent of clinical ly localised prostate cancer ( PCa ) .
EVIDENCE SYNTHESIS BRCA2 mutations have been added as risk factors for early and aggressive disease .
Systematic screening is still not recommended .
An early prostate-specific antigen test , the use of a risk calculator , or one of the promising biomarker tools are being investigated and might be able to limit the overdetection of insignificant PCa .
Breaking the link between diagnosis and treatment may lower the overtreatment risk .
Multiparametric magnetic resonance imaging using st and ardised reporting can not replace systematic biopsy , but robustly nested within the diagnostic work-up , it has a key role in local staging .
In Northern and Western Europe , the number of men diagnosed with PCa has been on the rise .