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Prostate Cancer · Radiation · Definitive Radiotherapy
PROFIT
In intermediate-risk localized prostate cancer, can 60 Gy in 20 fractions replace dose-escalated 78 Gy in 39 fractions?
Design
Phase III randomized non-inferiority
Treatment comparison
20 fractions versus 39 fractions
Experimental
60 Gy
20 fractions · 4 weeks
Moderately hypofractionated schedule.
Control
78 Gy
39 fractions · 7.8 weeks
Dose-escalated conventional fractionation.
Primary endpoint
Biochemical/clinical failure-free survival at 5 years
HR 0.96 (90% CI 0.77–1.20) · Prespecified non-inferiority criterion met. Absolute difference ≈0 percentage points. NNT is not applicable: this was a non-inferiority trial, not a superiority comparison.
Absolute effect · patient view
What changes for 100 patients?
≈0 percentage-point difference
The key patient-level effect is preservation of disease control rather than a demonstrated reduction in failures.
Treatment burden
19 fewer fractions
20 fractions instead of 39 — approximately 49% fewer treatment visits and about 3.8 weeks less treatment time.
Toxicity
Acute and late grade ≥2 gastrointestinal and genitourinary toxicity were broadly similar between schedules. The major practical advantage was reduction in treatment burden.
Important: NNH is not calculated here because the available page-level data do not provide a defensible fixed-time absolute toxicity difference.
Methodology
PROFIT deliberately targeted intermediate-risk disease and compared 60/20 with a higher conventional dose of 78/39. ADT was generally not used. The prespecified objective was to establish non-inferior disease control.
CHHiP versus PROFIT
CHHiP
Broader T1b–T3a localized population; 74/37 comparator; three-arm design; short-course ADT in most patients.
PROFIT
Intermediate-risk population; 78/39 comparator; two-arm design; generally no ADT.
The trials are complementary rather than interchangeable.
Our take
PROFIT supports 60 Gy in 20 fractions as an efficient definitive schedule for appropriately selected intermediate-risk prostate cancer. Its key contribution is preservation of cancer control against a dose-escalated 78-Gy schedule without routine ADT. The patient-level advantage is substantially lower treatment burden, not a demonstrated survival benefit.
Limitations
The findings apply to the trial population and treatment era. Non-inferiority should not be interpreted as proof that the shorter schedule is superior. Toxicity comparisons should be interpreted using the trial's prespecified definitions and follow-up.
Primary / authoritative source
Current-practice context · reviewed 14 October 2026
PROFIT established 60 Gy in 20 fractions over four weeks as a non-inferior, shorter alternative to 78 Gy in 39 fractions for appropriately selected intermediate-risk localized prostate cancer, with similar biochemical/clinical failure and late GI/GU toxicity. Moderate hypofractionation is now a standard external-beam option; choose the regimen according to risk group, target definition, image guidance, normal-tissue constraints, comorbidity and local expertise. PROFIT did not test concurrent ADT, which must be decided separately according to risk.
PROFIT primary randomized report ↗ · EAU prostate-cancer guidance ↗