ASTRO: What New Phase 3 Research Reveals About SBRT for Patients with Localized Prostate Cancer

Could stereotactic body radiotherapy (SBRT) be a viable alternative to radical prostatectomy in patients with localized prostate cancer (PCa)?

For a phase 3, randomized controlled trial, recently presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, researchers compared SBRT in 63 patients to radical prostatectomy in 60 patients. The patients (median age of 65.5) were drawn from eight facilities and had a median prostate-specific antigen (PSA) of 7.9 ng/mL. Over 94 percent of the cohort had low or intermediate-risk PCa, according to the study.

The study authors found that 94.8 percent of the SBRT cohort achieved freedom from biochemical/clinical failure (BCF) at five years in comparison to 94.1 percent for the radical prostatectomy group. Researchers also saw no statistically significant difference with freedom from BCF at eight years (91.2 percent for the SBRT group and 83.7 percent for those who had a radical prostatectomy.

“With long-term follow-up, both prostatectomy and SBRT achieved excellent biochemical control in patients with (localized) prostate cancer. These findings support SBRT as an effective non-surgical treatment option with comparable long-term disease control to prostatectomy,” emphasized lead study author Nicholas van As, MD, MB, the medical director at the Royal Marsden Hospital in London.

Patients in the SBRT cohort had a nearly 40 percent lower rate of self-reported urinary incontinence (defined as use of one urinary pad) at five years in contrast to patients in the radical prostatectomy arm of the study (8.3 percent vs. 48 percent), according to the study authors.

The researchers noted comparable grade 0/1 gastrointestinal (GI) side effects for both cohorts and one case of a grade 2 or higher side effect in the SBRT group at five years. The study authors also pointed out similar percentages of grade 0/1 genitourinary (GU) side effects and a low number of grade 2 or higher side effects (one case in the radical prostatectomy group and two cases in the SBRT cohort.

“The randomized findings support SBRT as an effective non-surgical treatment option and there were low … rates of side effects in both arms. … I therefore think all patients who are considering a radical prostatectomy should be given information about SBRT before they make their treatment decisions,” added Dr. Van As during an ASTRO press briefing.

Reference

1. Van As N, Patel J, Tree A, et al. Efficacy of radical prostatectomy versus stereotactic body radiotherapy (SBRT) for localized prostate cancer: results from an international phase III randomised controlled trial (PACE-A). Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, September 26-September 30, 2026, Boston. Available at: https://amportal.astro.org/sessions/pl-01-22946/efficacy-of-radical-prostatectomy-versus-stereotactic-body-radiotherapy-sbrt-for-localised-pr-114308 .