Shorter Radiation After Prostate Surgery Controlled Cancer as Well at 5 Years, With a Trade-Off

When prostate cancer returns or is at high risk of returning after surgery, radiation to the prostate bed (the area where the prostate used to be) is often recommended. The standard course takes about seven weeks of daily treatments, five days a week. For many men, that means more than a month of daily trips to a treatment center, along with time off work, travel costs and fatigue. A shorter schedule would mean two fewer weeks of visits, but is it as good?

Five-year results from the phase 3 NRG Oncology GU003 trial, presented at the American Society for Radiation Oncology (ASTRO) 2026 Annual Meeting by Dr. Mark Buyyounouski of Stanford University, offer the clearest answer yet.

"Postoperative radiation can be delivered in a shorter five-week course of 25 treatments without compromising long-term cancer control or patient-reported quality of life," Buyyounouski said.

What the Trial Compared

The trial included 296 men who had their prostate removed. They were randomly assigned to:

• Conventional radiation: 37 treatments of 1.8 Gy each (66.6 Gy total) over about seven weeks, or
• Hypofractionated radiation: 25 slightly larger treatments of 2.5 Gy each (62.5 Gy total) over about five weeks.

Gy (gray) is the unit used to measure a radiation dose. Hypofractionation means giving a somewhat larger dose at each visit so the full course can be finished in fewer visits.

Men were followed for a median of seven years.

How We Got Here

These are the trial's longest-term results so far. In November 2021, researchers first reported at ASTRO that the two schedules caused similar bowel and urinary side effects during the first year. CURE covered those early findings at the time.

In March 2024, two-year results published in JAMA Oncology found that men's own reports of bowel and urinary symptoms were similar with either schedule. Based on those findings, NRG Oncology described the shorter course as a new acceptable standard of care. The five-year data were the key test of whether cancer control and side effects would hold up over time.

What It Found

• Cancer control: At five years, PSA levels had risen, a sign the cancer may be returning, in 21% of men who received the shorter schedule and 18% who received the standard schedule. That difference was not statistically significant.
• Deaths from prostate cancer: These were rare. Four men in the whole trial died of prostate cancer during follow-up.
• Quality of life: Men's own reports of bowel and urinary symptoms, and of their overall quality of life, were similar between the two groups at five years.
• Serious side effects: Grade 3 or higher side effects were more common with the shorter schedule (16% vs 7%). These are side effects serious enough to need medical treatment or limit daily activities. Most of the difference came from urinary problems (13% vs 3%):
  • Bladder irritation and inflammation (cystitis) affected 7% of men on the shorter schedule and none on the standard schedule.
  • Blood in the urine affected 6% vs less than 1%.
• No life-threatening side effects: No grade 4 or 5 side effects occurred in either group.

What It Means for You

The shorter course saves two weeks of treatment visits and appears to control cancer about as well. That can matter a great deal for men who live far from a treatment center, work full time or rely on others for rides. The higher rate of serious urinary side effects is a real trade-off, though.

The researchers noted that doctors will need to decide how much weight to give the side effect findings, especially when a shorter course could make treatment easier to access.

For some men, fewer trips will matter most. For others, especially those who already have urinary problems after surgery, the standard schedule may be the better fit.

Shorter courses are being studied in other settings too. In August 2026, CURE reported on a separate trial in which men who received salvage radiation in fewer visits had similar results.

Questions to Ask Your Radiation Oncologist

• Am I a candidate for a shorter schedule after surgery?
• Given my current urinary symptoms, which schedule do you recommend?
• Will I also receive hormone therapy, and does that change which schedule you'd suggest?
• What urinary side effects should I report, and how are they treated?

References

1. "Hypofractionated Radiotherapy for Prostate Cancer Matches Conventional Treatment Outcomes." News-Medical. Sept. 27, 2026.
2. "Shorter Prostate RT Holds Up at 5 Years, With Caveats." Medscape. September 2026.
3. "Hypofractioned Post-Prostatectomy Radiotherapy New Acceptable Practice Standard Based on NRG Oncology Trial Findings." NRG Oncology. March 14, 2024.

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