Top Line: Does dose-escalation of prostate radiation still move the needle in the setting of long-course androgen deprivation therapy (ADT)?
The Study: The French phase 3 trial GETUG-AFU 18 randomized 505 men receiving definitive conventionally-fractionated radiation for high-risk prostate cancer to 70 versus 80 Gy with three years of ADT in both arms. Prior dose-escalation studies largely enrolled lower-risk populations and often used no or short-course ADT. Here, 80 Gy improved 10-year biochemical or clinical progression-free survival from 72% to 84% (HR 0.56). The trial also reported higher 10-year prostate cancer-specific survival (96% vs 90%) and–surprisingly–overall survival (77% vs 66%). That last one is a provocative departure from the historical dose-escalation literature where better biochemical control has not translated into survival gains. That is likely because the unexpected divergence in overall survival was driven substantially by fewer unrelated non-prostate cancer deaths in the dose-escalation arm. In the setting of contemporary sophisticated imaging and focal boosting, the next best question may be the reverse: does ADT prolongation still move the needle in the setting of modern dose-escalated radiation?
TBL: GETUG-AFU 18 demonstrates that local radiation dose intensification still adds value on top of prolonged ADT in high-risk prostate cancer. | Hennequin, Lancet Oncol 2026
The Study: The French phase 3 trial GETUG-AFU 18 randomized 505 men receiving definitive conventionally-fractionated radiation for high-risk prostate cancer to 70 versus 80 Gy with three years of ADT in both arms. Prior dose-escalation studies largely enrolled lower-risk populations and often used no or short-course ADT. Here, 80 Gy improved 10-year biochemical or clinical progression-free survival from 72% to 84% (HR 0.56). The trial also reported higher 10-year prostate cancer-specific survival (96% vs 90%) and–surprisingly–overall survival (77% vs 66%). That last one is a provocative departure from the historical dose-escalation literature where better biochemical control has not translated into survival gains. That is likely because the unexpected divergence in overall survival was driven substantially by fewer unrelated non-prostate cancer deaths in the dose-escalation arm. In the setting of contemporary sophisticated imaging and focal boosting, the next best question may be the reverse: does ADT prolongation still move the needle in the setting of modern dose-escalated radiation?
TBL: GETUG-AFU 18 demonstrates that local radiation dose intensification still adds value on top of prolonged ADT in high-risk prostate cancer. | Hennequin, Lancet Oncol 2026