External beam radiotherapy for prostatic cancers: 2025 update

This article reports on the updated recommendations of the Société française de radiothérapie oncologique on external radiotherapy for prostate cancer. External radiotherapy is aimed for all localized prostate cancers, and more recently at oligometastatic prostate cancers. Irradiation techniques are detailed according to different risk levels. Prostate image-guided intensity-modulated radiotherapy is the recommended technique for these cancers. A total dose of 74 to 80Gy is recommended for standard fractionation (delivered in 2Gy fractions). Moderate hypofractionation (delivering a total dose of 60Gy at a rate of 3Gy per fraction over 4weeks) in the prostate has become a therapeutic standard. Extreme hypofractionation (delivering 35 to 40Gy in five fractions) to treat the prostate without pelvis, using a technique under stereotactic conditions, can be considered a recent standard in favourable and intermediate risk disease. The postoperative irradiation technique, mainly indicated in cases of biochemical recurrence and lymph node involvement, is described in detail. Recommendations concerning contouring and dosimetry are also provided.