Urology: Prostate radical RT hypofractionation
Free question published 21 July 2026
A 71-year-old man with intermediate-risk localised prostate cancer (cT2a, Gleason 3+4=7, PSA 9 ng/mL) elects radical external beam radiotherapy after multidisciplinary discussion. He has no inflammatory bowel disease and no prior pelvic radiotherapy, and image-guided IMRT is available. What is the most appropriate first-line fractionation schedule?
- A60 Gy in 20 fractions using image-guided IMRT
- B74 Gy in 37 fractions using conventional fractionation
- C36.25 Gy in 5 fractions using stereotactic body radiotherapy
- D55 Gy in 20 fractions using 3D-conformal radiotherapy
- E64 Gy in 32 fractions using image-guided IMRT
Why A is correct
NICE NG131 (recommendation 1.3.19) and the CHHiP trial support moderate hypofractionation: offer 60 Gy in 20 fractions using image-guided IMRT as first-line, reserving 74 Gy in 37 fractions for those who cannot have hypofractionation. CHHiP showed 60 Gy in 20 fractions was non-inferior to 74 Gy in 37 fractions at 5 years without a significant increase in late toxicity.
And why the others are not
- BIncorrect first-line: conventional 74 Gy in 37 fractions is reserved by NICE NG131 for people who cannot have hypofractionated radiotherapy.
- CIncorrect: 5-fraction SBRT is not the NICE NG131 first-line standard for routine radical prostate radiotherapy in this scenario.
- DIncorrect: 55 Gy in 20 fractions is not the validated dose, and CHHiP/NICE specify image-guided IMRT rather than 3D-conformal radiotherapy.
- EIncorrect: 64 Gy in 32 fractions is not a NICE-recommended schedule for localised prostate cancer.
Source NICE NG131 — Prostate cancer: diagnosis and management — National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE guideline NG131. Published 09/05/2019, updated 15/12/2021.
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