Editing Management of Localized Prostate Cancer (section)

===== Stereotactic body radiotherapy (SBRT) =====

====== <span style="color:#ff00ff">Prostate Advances in Comparative Evidence======

* Multi-arm trial
** PACE-A: SBRT vs. surgery
** PACE-B and PACE-C: patients who were suitable candidates for radical radiotherapy but were not suitable candidates for or who were unwilling to undergo radical prostatectomy
* PACE-B (NEJM 2024)
** Population: 874 patients with NCCN low- or intermediate-risk prostate cancer
** Randomized to SBRT vs. control radiotherapy (conventional or moderately hypofractionated)
** Outcomes
*** Primary: freedom from biochemical or clinical failure at 5 years
*** Secondary: commencement of ADT, diagnosis of metastatic disease, disease-free survival, overall survival, and clinician- and patient-assessed side effects
** Results:
*** Freedom from biochemical or clinical failure at 5 years: 96% SBRT vs. 95% control radiotherapy
*** Cumulative toxicity grade 2 or higher GU toxic effects: 29% SBRT vs. 18% conventional radiotherapy
*** Cumulative toxicity grade 2 or higher GI toxic effects: 11% SBRT vs. 10% conventional radiotherapy
**[https://pubmed.ncbi.nlm.nih.gov/39413377/ van As, Nicholas, et al. "Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer." ''New England Journal of Medicine'' 391.15 (2024): 1413-1425.]