Christina E. Henson, MD, describes how recent trial-based research has established new standards in prostate cancer radiotherapy. She discusses several modes of therapy, including hypofractionation, metastasis-directed therapy for treating oligometastatic disease, and pelvic nodal irradiation, noting that research has shown them to be effective treatments in a variety of disease states. Ultra-hypofractionation has been proven to have an increased therapeutic ratio compared to other methods, as well as a 5-year failure-free survival of 84% across all trials. Elective nodal radiation up to L4 or higher is now recommended to maximize treatment outcomes. Metastasis-directed therapy has been proven to help patients even with limited disease burden and should be viewed as an option in these cases, though it is not always successful.
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