Avkshtol V, Ruth KJ, Ross EA, et al. - Given that moderate hypofractionated intensity-modulated radiation therapy (H-IMRT) vs conventionally fractionated IMRT (C-IMRT) has not been shown to be superior in terms of 5-year biochemical and/or clinical disease failure (BCDF) rate in the previously published single-institution randomized prospective trial, so, researchers report 10-year disease outcomes utilizing updated risk groups as well as definitions of biochemical failure. Using randomization, men having protocol-defined intermediate- and high-risk prostate adenocarcinoma were allocated to receive C-IMRT (76 Gy in 38 fractions) or H-IMRT (70.2 Gy in 26 fractions). A median follow-up of 122.9 months was performed. In the C-IMRT arm and in the H-IMRT arm, the 10-year cumulative incidence of BCDF was estimated to be 25.9% and 30.6%, respectively. In terms of cumulative 10-year rates of biochemical failure, prostate cancer-specific mortality, and overall mortality, similar outcomes were evident in the two arms. However, a higher 10-year cumulative incidence of distant metastases was reported in the H-IMRT arm. Overall, findings revealed the non-superiority of H-IMRT vs C-IMRT in terms of long-term disease outcomes.