ASTRO 2026 | Five-Treatment SBRT Demonstrates Long-Term Effectiveness for Localized Prostate Cancer
New findings from a phase 3 randomized clinical trial presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting reveal promising results for stereotactic body radiation therapy (SBRT) as a non-surgical treatment for localized prostate cancer. The PACE-A trial, which is the first of its kind to compare SBRT directly with prostatectomy, showed that SBRT maintains excellent long-term cancer control with fewer urinary and sexual side effects compared to surgical options.
The trial followed 123 patients over a median period of eight years. The data indicated that 91% of patients treated with SBRT remained free of biochemical or clinical failure, similar to the 84% success rate observed in patients who underwent surgery. While these results were not statistically significant due to the trial's design, they suggest that SBRT provides effective cancer control over time.
Nicholas van As, MD, principal investigator and professor at the Institute of Cancer Research in London, highlighted the importance of these findings. "Patients with localized prostate cancer face a difficult choice between surgery and radiation therapy. The PACE-A trial provides long-term data clarifying that both treatments offer comparable cancer control, with SBRT providing distinct benefits for urinary continence and sexual function."
The study noted that SBRT delivers targeted radiation treatment across five outpatient sessions, aiming to minimize exposure to surrounding healthy tissues. This approach contrasts with radical prostatectomy, which involves the surgical removal of the prostate.
Moreover, the trial reported that at five years, 94% of SBRT patients remained failure-free, matching the 95% rate for those who had surgery. Furthermore, SBRT patients experienced a lower incidence of urinary incontinence, with only 8% requiring urinary pads compared to 48% in the prostatectomy group. Sexual function also showed marked improvement among SBRT patients, with median erectile-function scores significantly better than those of the surgical cohort.
These outcomes emphasize the importance of considering both cancer control and quality of life when choosing a treatment plan. While the PACE-A data primarily apply to patients with favorable intermediate-risk disease, ongoing research in the PACE program is expanding SBRT's use in various prostate cancer settings, including those involving hormone therapy for higher-risk cases.
The study also underscores the significance of collaborative care, whereby patients consult with both surgeons and radiation oncologists to understand fully their treatment options and anticipated outcomes.