Prostate Cancer Treatment Trial Shows Radiotherapy Matches Surgery's Efficacy with Fewer Side Effects

Thousands of men diagnosed with prostate cancer may be able to avoid the significant urinary and sexual side effects associated with surgical removal of the prostate, according to findings from a recent study. A first-of-its-kind trial revealed that a five-session radiotherapy treatment, known as stereotactic body radiation therapy (SBRT), achieved comparable cancer control to radical prostatectomy but with fewer major side effects.

After eight years of follow-up, 91% of men who received SBRT showed no signs of their cancer returning, compared to 84% of those who underwent surgery. Patients treated with radiotherapy also reported less urinary incontinence and sexual dysfunction two years after treatment, benefits that the new study suggests persist in the long term.

Prostate cancer is the most common cancer among men, with over 68,000 new cases diagnosed annually in the UK. For many, surgical removal of the prostate gland is a primary treatment option. However, this procedure often results in erectile dysfunction and can impact a man's ability to conceive naturally. While SBRT limits exposure to nearby healthy tissue by directly targeting tumors using advanced imaging, doctors say that not all patients are fully informed about their treatment alternatives.

The PACE-A trial, presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), involved 123 men with low- or intermediate-risk prostate cancer who were treated between 2012 and 2022. Participants were randomly assigned to either a radical prostatectomy or five sessions of SBRT. Neither group received hormone therapy.

Researchers tracked patients for signs of cancer recurrence, disease progression, or the need for further treatment. Over the study's follow-up period, there were 13 treatment failures, with eight occurring in the surgery group and five in the radiotherapy group. The rates of cancer returning were nearly identical in both groups five years after treatment.

Long-term functional outcomes were also assessed. Just 8% of men treated with SBRT reported using at least one urinary pad five years post-treatment, a stark contrast to the 48% of men who had undergone surgery. Bowel problems were uncommon in both groups. Regarding sexual function, patient-reported scores declined over time in both arms of the study, but remained significantly better for those treated with SBRT. Five years after treatment, erectile function scores, measured on a scale of 25, averaged 19 for SBRT patients compared to 5 for surgery patients.

Dr. Nicholas van As, a consultant clinical oncologist and lead author of the study, emphasized the importance of patient awareness. "Patients should know that surgery is not their only curative treatment option and have the opportunity to discuss the benefits and side effects of both approaches," he stated. He added that the longer-term data provide a fuller picture of expected outcomes for each treatment.

Experts not involved in the study concur. Dr. Amar Kishan, a radiation oncologist, noted that the trial directly compared contemporary surgical methods with five-treatment radiation, offering durable cancer control with persistently better sexual and urinary function with SBRT. This comprehensive data allows patients to make more informed decisions.

The UK National Screening Committee recently rejected proposals for a national prostate cancer screening program, citing concerns about potential over-diagnosis and over-treatment leading to unnecessary side effects like impotence and incontinence. The findings from the PACE-A trial suggest that alternative treatments like SBRT may offer a way to manage the disease effectively while preserving quality of life for a greater number of patients.