Prostate Cancer Radiotherapy: Five-Session SBRT May Rival Surgery A five-session radiotherapy treatment for prostate cancer, SBRT, matched surgery in cancer control at eight years while reducing urinary and sexual side effects, a UK trial found. A five-session radiotherapy treatment for prostate cancer may offer a less invasive alternative to surgery, according to a first-of-its-kind UK trial. The study, presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), found that after eight years, 91 per cent of men who received stereotactic body radiation therapy (SBRT) showed no signs of cancer returning, compared with 84 per cent of those who underwent surgery. The PACE-A trial followed 123 men from eight centres across the UK between 2012 and 2022. Prostate Cancer Treatment Options ComparedThe trial randomly assigned men to either a radical prostatectomy, which removes the prostate gland, or five sessions of SBRT. Most participants had low- or intermediate-risk prostate cancer and were around 66 years old. Neither group received hormone therapy. Researchers monitored for cancer return or worsening, including rising PSA levels, disease spread, need for hormone treatment, or prostate cancer-related death.Over the follow-up period, there were 13 treatment failures: five among men treated with radiotherapy and eight among those who had surgery. At five years, cancer return rates were almost identical in both groups. The study was not designed to prove which treatment is better at controlling the disease, so researchers cannot definitively say radiotherapy was more effective overall.Dr Nicholas van As, a consultant clinical oncologist at The Royal Marsden and study lead author, said that few cancer failures were seen in either group and that the data show excellent outcomes with five-treatment radiotherapy.Radiotherapy Reduces Urinary and Sexual Side EffectsMen who received SBRT experienced less urinary incontinence and sexual dysfunction two years after treatment, and the new study suggests these benefits continue longer term. At five years, just 8 per cent of men treated with SBRT reported using at least one urinary pad, compared with 48 per cent of those who had surgery.Separate findings presented at ASTRO focused on sexual function. Patient-reported sexual function scores declined in both groups over time, but remained significantly better after radiation. Five years after treatment, erectile-function scores—measured on a scale of 25, with higher scores indicating better function—were 19 for SBRT patients and 5 for surgery patients.Bowel problems were uncommon in both groups. The research team previously found that bowel-related side effects were more common with SBRT, but the new study indicates the urinary and sexual benefits persist.Access to Radiotherapy and Prostate Cancer ScreeningSBRT uses advanced imaging to directly target tumours while limiting exposure to nearby tissue. The treatment was approved for routine use on the NHS in June, but doctors at The Royal Marsden, who led the study, say too many men are still not made aware of their options.Dr van As said that in their practice, patients generally meet both a surgeon and a radiation oncologist, but that does not happen everywhere. He emphasized that patients should know surgery is not their only curative treatment option and have the opportunity to discuss the benefits and side effects of both approaches.Dr Amar Kishan, a radiation oncologist not involved in the study, said the results show durable cancer control with both approaches and persistently better sexual and urinary function with SBRT. He added that these longer-term data give patients a more complete picture of what to expect from each treatment.Prostate cancer is the most common cancer in men, with over 68,000 diagnosed each year in the UK. Earlier this year, the UK National Screening Committee rejected proposals for a national prostate cancer screening programme. The Daily Mail is campaigning to end needless prostate deaths and backing prostate cancer screening for men at high risk of the disease.