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Robotic Stereotactic Body Radiation Therapy for High-Risk Prostate Cancer: The Georgetown University Experience.

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Stereotactic body radiation therapy (SBRT) offers excellent cancer control for high-risk prostate cancer (PCa) patients, with 89% disease-free at three years. SBRT also preserves patient quality of life, with urinary and bowel functions returning to near baseline levels.

Keywords:
biochemical recurrencebowel functionhigh-risk prostate cancerhypofractionationlong-term effectsquality of lifestereotactic body radiotherapyurinary function

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Urology

Background:

  • Stereotactic body radiation therapy (SBRT) is a conformal, hypofractionated treatment effective for low- and intermediate-risk prostate cancer (PCa).
  • High-risk (HR) PCa traditionally uses conventional radiotherapy, which can be burdensome for elderly patients.
  • Long-term patient-reported outcomes for HR PCa treated with SBRT are limited.

Purpose of the Study:

  • To evaluate cancer control and health-related quality of life (HRQOL) in high-risk prostate cancer patients treated with robotic SBRT.
  • To assess long-term outcomes of SBRT for high-risk prostate cancer patients.

Main Methods:

  • Retrospective analysis of HR PCa patients treated with robotic SBRT (7-7.25 Gy/5 fractions).
  • Biochemical failure defined by Phoenix criteria (PSA rise ≥2 ng/mL).
  • HRQOL assessed using the EPIC-26 questionnaire at multiple time points post-treatment.

Main Results:

  • Three-year biochemical disease-free rate was 89% in 216 HR PCa patients (median age 75, median follow-up 40 months).
  • Most common failures: bone metastases (34.15%), PSA-only (24.39%), local (17.08%), lymph node (12.2%).
  • Urinary and bowel HRQOL scores remained near baseline at 3 years post-SBRT, with no statistically or clinically significant changes.

Conclusions:

  • Robotic SBRT achieves favorable cancer control in high-risk prostate cancer patients.
  • SBRT demonstrates excellent tolerability and minimal impact on patient quality of life, with urinary and bowel functions largely preserved.
  • SBRT is a convenient and effective treatment option for high-risk prostate cancer, offering promising oncologic outcomes and maintaining patient quality of life.