Shorter Postprostatectomy Radiation Matches Standard Course

Patients with prostate cancer can receive radiation after prostatectomy in 25 treatments over 5 weeks instead of 37 treatments over 7 weeks. Long-term data from the NRG-GU003 trial show the shorter course does not worsen cancer control or patient-reported quality of life. The phase 3 trial did find a higher rate of physician-reported grade 3 urinary toxicity with the shorter schedule. Investigators said clinicians will need to weigh this finding when choosing a fractionation schedule.

The results were presented at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting in Boston.

What did the NRG-GU003 trial compare?

NRG-GU003 (NCT03274687) was a randomized, phase 3 noninferiority trial. It enrolled patients who needed postprostatectomy radiotherapy.

Patients received 1 of 2 schedules:

• Hypofractionated postprostatectomy radiotherapy (HYPORT): 62.5 Gy delivered in 25 fractions of 2.5 Gy.
• Conventional postprostatectomy radiotherapy (COPORT): 66.6 Gy delivered in 37 fractions of 1.8 Gy.

The trial accrued 296 eligible patients. Randomization was stratified by baseline Expanded Prostate Cancer Index Composite (EPIC) urinary and bowel scores and by prior use of androgen deprivation therapy.

The primary objective was to determine whether HYPORT was noninferior to COPORT for patient-reported urinary and bowel symptoms at 2 years. Investigators previously reported that the trial met this endpoint.

How did long-term patient-reported outcomes compare?

Patient-reported outcomes stayed similar between arms through 5 years. Mean change from baseline in EPIC scores was as follows:

• Bowel symptoms: 0.6 with COPORT and −2.0 with HYPORT (P = .1).
• Urinary symptoms: −5.7 with COPORT and −8.0 with HYPORT (P = .4).
• Quality of life (EQ-5D): −0.01 with COPORT and 0.0 with HYPORT (P = .5).

Did the shorter schedule maintain cancer control?

At a median follow-up of 7 years, the 5-year biochemical failure rate was 18% with COPORT and 21% with HYPORT. The difference was not statistically significant (P = .3).

Investigators reported 31 deaths in total, 4 of which were attributed to prostate cancer.

What toxicity differences should nurses know about?

Physician-reported grade 3 adverse events occurred in 16% of patients in the HYPORT arm and 7% in the COPORT arm (P = .02).

Most of the difference came from grade 3 renal and urinary disorders, which affected 13% of patients receiving HYPORT and 3% of those receiving COPORT (P = .003). Within this category:

• Noninfective cystitis occurred in 7% of patients receiving HYPORT and in no patients receiving COPORT.
• Hematuria occurred in 6% of patients receiving HYPORT and 0.7% of those receiving COPORT.

No grade 4 or 5 radiation-related adverse events were reported in either arm. Time to a grade 3 adverse event did not differ between arms (P = .4)

What did investigators say about the findings?

"Postoperative radiation is an important part of preserving the opportunity for cure in patients with PSA recurrence after prostatectomy," said lead author Mark Buyyounouski, MD, MS, FASTRO, of Stanford University, in a news release detailing the findings. "Traditionally, treatment has required 37 sessions over approximately seven weeks, which can make it difficult for some patients to receive and burdensome for those who do. These findings show that 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 also addressed why patient-reported and physician-reported results differed. "While long-term patient-reported urinary outcomes were similar, physician-reported Grade 3 urologic toxicity was increased with hypofractionation. The reason for that difference is unknown," he said. "Physician-reported toxicity primarily captures clinical events and the interventions they require, while patient-reported outcomes capture symptoms, function, and how treatment affects patients' daily lives. These measures provide different, complementary perspectives on treatment effects. Physicians will need to decide how much weight to give the toxicity findings when choosing a fractionation schedule, particularly when a shorter course could improve access to care, reduce treatment burden, or even make postoperative radiation possible."

How does this fit with other hypofractionation data in prostate cancer?

Shorter radiation schedules are already used in the definitive setting for prostate cancer. For example, the RTOG 0415 trial compared 70 Gy in 28 fractions with 73.8 Gy in 41 fractions in patients with low-risk prostate cancer. Hypofractionation was noninferior for disease-free survival at 12 years.

NRG-GU003 adds long-term evidence for the postprostatectomy setting, where conventional fractionation has been the traditional approach.

What are the key takeaways for oncology nurses?

• Fewer visits: A 25-fraction postprostatectomy schedule removes about 12 treatment visits and 2 weeks of daily travel compared with conventional fractionation. This may matter for patients facing transportation, work, or caregiving barriers.
• Similar quality of life: Patient-reported bowel, urinary, and quality-of-life outcomes were similar between schedules at 5 years.
• Urinary toxicity monitoring: Physician-reported grade 3 urinary toxicity was higher with HYPORT (13% vs 3%), including noninfective cystitis and hematuria. Teach patients to report blood in the urine, painful urination, urgency, or urinary retention promptly, and continue urinary symptom assessment during survivorship follow-up.
• Two types of toxicity data: Patient-reported and clinician-reported measures can diverge. Documenting both symptom burden and clinical events gives the care team a fuller picture.
• Shared decision-making: Nurses can help patients understand the trade-off between a shorter course and a higher risk of severe urinary events as the care team chooses a schedule.

References

1. Shortened radiation schedule provides similar cancer control and patient-reported outcomes to standard radiation following surgery for high-risk prostate cancer in NRG Oncology trial. News release. NRG Oncology. September 27, 2026. Accessed October 1, 2026. https://www.nrgoncology.org/Home/News/Post/shortened-radiation-schedule-provides-similar-cancer-control-and-patient-reported-outcomes-to-standard-radiation-following-surgery-for-high-risk-prostate-cancer-in-nrg-oncology-trial/
2. Buyyounouski MK, Pugh SL, Chen RC, et al. Noninferiority of hypofractionated vs conventional postprostatectomy radiotherapy for genitourinary and gastrointestinal symptoms: the NRG-GU003 phase 3 randomized clinical trial. JAMA Oncol. 2024;10(5):584-591. doi:10.1001/jamaoncol.2023.7291
3. Hypofractionated post-prostatectomy radiation therapy in treating patients with prostate cancer (NRG-GU003). ClinicalTrials.gov identifier: NCT03274687. Updated 2026. Accessed October 1, 2026. https://clinicaltrials.gov/study/NCT03274687
4. Hollasch M. Hypofractionation noninferior to conventional radiotherapy for low-risk prostate cancer. Oncology Nursing News. July 8, 2024. Accessed October 1, 2026. https://www.oncnursingnews.com/view/hypofractionation-noninferior-to-conventional-radiotherapy-for-low-risk-prostate-cancer