Radical Prostatectomy Versus Stereotactic Radiotherapy for Clinically Localised Prostate Cancer: Results of the...

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Limited patient-reported outcomes (PROs) data exist for stereotactic body radiotherapy (SBRT) versus prostatectomy in localized prostate cancer.
• The PACE-A trial aimed to compare quality of life between these treatment modalities.

Purpose of the Study:

• To compare patient-reported health-related quality of life (HRQoL) between SBRT and prostatectomy for localized prostate cancer.
• To evaluate urinary, bowel, and sexual function outcomes in patients treated with SBRT or prostatectomy.

Main Methods:

• Phase 3 open-label, randomized controlled trial (PACE-A) comparing SBRT and prostatectomy (1:1 ratio).
• Included men with low- to intermediate-risk localized prostate cancer; androgen deprivation therapy was not permitted.
• Coprimary outcomes included urinary pad usage and bowel domain scores from the Expanded Prostate Index Composite (EPIC-26) at 2 years.

Main Results:

• At 2 years, SBRT significantly reduced daily urinary pad use (6.5% vs. 50% for prostatectomy; p < 0.001).
• Bowel domain scores were better with prostatectomy (p < 0.001), while sexual function scores were significantly better with SBRT.
• SBRT was associated with less patient-reported urinary incontinence and sexual dysfunction compared to prostatectomy.

Conclusions:

• SBRT offers advantages in patient-reported urinary incontinence and sexual function compared to prostatectomy for localized prostate cancer.
• While SBRT showed slightly more bowel bother, the overall PROs suggest it is a viable treatment option.
• These findings provide crucial randomized data to guide treatment decisions for patients with localized, intermediate-risk prostate cancer.