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Urology: Prostate radical RT hypofractionation and concurrent ADT

Free question published 06 October 2026

UrologyProstate radical RT hypofractionation and concurrent ADT

A 69-year-old man with high-risk localised prostate cancer (cT3a N0 M0, Gleason 4+4=8, PSA 22 ng/mL) is to have radical external beam radiotherapy with neoadjuvant and concurrent androgen deprivation therapy. Image-guided IMRT is available and he has no contraindication to hypofractionation. What is the most appropriate radiotherapy dose-fractionation schedule?

  1. A70 Gy in 28 fractions
  2. B66 Gy in 22 fractions
  3. C57 Gy in 19 fractions
  4. D62 Gy in 20 fractions
  5. E60 Gy in 20 fractions

Why E is correct

CHHiP randomised men to 74 Gy/37#, 60 Gy/20# or 57 Gy/19#. At 5 years, 60 Gy in 20 fractions was non-inferior to 74 Gy in 37 fractions for biochemical or clinical failure-free survival without a significant increase in late toxicity, and was concluded to be a new standard of care. 57 Gy/19# did not meet the non-inferiority threshold and is not the recommended standard.

And why the others are not

  • AIncorrect: 70 Gy in 28 fractions was not tested in CHHiP and is not the recommended schedule.
  • BIncorrect: 66 Gy in 22 fractions was not a CHHiP arm or a NICE-recommended schedule.
  • CIncorrect: 57 Gy in 19 fractions was a CHHiP arm but did not demonstrate non-inferiority to 74 Gy/37#, so it is not the adopted standard.
  • DIncorrect: 62 Gy in 20 fractions was not a CHHiP arm.

Source CHHiP — Conventional versus hypofractionated high-dose IMRT for prostate cancer (5-year outcomes) — Dearnaley D, Syndikus I, Mossop H, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol 2016;17(8):1047-1060.

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