New data, presented to the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting, suggests that patients with low-to-intermediate-risk prostate cancer can safely have a highly targeted form of radiotherapy instead of having their prostate surgically removed. 

Dr Amar Kishan, ASTRO Genitourinary Cancer Resource Panel Chair and a radiation oncologist at UCLA commented:  

“Patients choosing treatment for localized prostate cancer want to know how well it will control their cancer and how it may affect their daily lives. This study (PACE-A) directly compared contemporary surgery with five-treatment radiation and followed patients long enough to address both questions. The results show durable cancer control with both approaches, and persistently better sexual and urinary function with SBRT. Together, these longer-term data give patients a more complete picture of what they can expect from each treatment,” 

Researchers, led by experts at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, looked at 123 patients with low or intermediate-risk prostate cancer who were tracked for an average of eight years after treatment.

Half of the men were given surgery to remove their prostate, whilst the other half were given stereotactic body radiotherapy (SBRT) five times over one to two weeks.

During the follow-up period, the cancer had returned or progressed in five of the SBRT group and eight in the surgical group.

After eight years, 91.2% of men who were given radiotherapy remained free from signs that their cancer had returned or progressed, compared with 83.7% in the surgical group.

“It is essential that patients with prostate cancer are aware of all the options available to them,” said Professor Nicholas van As, chief investigator of the PACE-A trial, consultant clinical oncologist at The Royal Marsden NHS Foundation Trust, and professor in precision prostate radiotherapy at The Institute of Cancer Research, London.

“The numbers favour SBRT, but there were too few cancer events to conclude that it was superior, what we can say is that we saw very few cancer failures in either group, and that we have mature data showing excellent cancer outcomes with five-treatment radiotherapy.”

“Treatment choices are often driven by the desire to preserve long-term urinary and sexual function, but until now we have had limited randomised evidence comparing the long-term cancer outcomes of surgery and SBRT.  This PACE-A trial was designed to address this gap.”

Survey responses from the patients five years after treatment showed that 8.3 per cent of patients in the radiotherapy group reported daily use of a urinary pad, compared with 48 per cent of those who had a prostatectomy.

Similarly sexual-function scores declined in both groups but remained significantly better after SBRT. At five years, median erectile-function scores on a 25-point scale, where higher scores indicate better function, were 19 after SBRT and 5 after prostatectomy.

In conclusion these results show that SBRT appears to achieve comparable long-term cancer control outcomes when compared to surgery, helping patients make more informed decisions about their care.