SBRT and Surgery Show Similar Disease Control in Localized Prostate Cancer in PACE-A

Stereotactic body radiotherapy (SBRT) and radical prostatectomy achieved comparable long-term freedom from biochemical or clinical failure (BCF) in men with localized prostate cancer in the phase 3 PACE-A trial, presented as a late-breaking abstract at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting.

PACE (NCT01584258) is an open-label, multicohort phase 3 trial. In PACE-A, surgery-eligible men with cT1c-T2c disease, a Gleason score of 3+4 or lower, and a prostate-specific antigen level of 20ng/mL or less were randomized 1:1 to SBRT (36.25 Gy in 5 fractions) or prostatectomy. Androgen deprivation therapy was not permitted. The co-primary endpoints of 2-year pad use and bowel bother were published previously; the current analysis covered secondary endpoints, Urology Times reported.

Between August 2012 and February 2022, 123 patients from 8 centers were randomized (63 SBRT, 60 prostatectomy). Most patients (94.3%) had intermediate-risk disease. After a median follow-up of 8 years, 13 BCF events had occurred (5 SBRT, 8 prostatectomies; hazard ratio, 0.48; 95% CI, 0.16-1.46; P=.18). BCF-free rates were 94.8% with SBRT and 94.1% with prostatectomy at 5 years and 91.2% and 83.7%, respectively, at 8 years. No deaths from prostate cancer occurred.

At 5 years, 48% of prostatectomy patients (14/29) and 8.3% of SBRT patients (3/36) reported using at least 1 urinary pad daily. One prostatectomy patient and no SBRT patients reported a moderate or big bowel problem. Clinician-reported grade ≥2 gastrointestinal toxicity occurred in 2% of SBRT patients and no prostatectomy patients; grade ≥2 genitourinary toxicity occurred in 3.8% and 2.5%, respectively.

The investigators concluded that both treatments achieved excellent biochemical control and that the findings support SBRT as an effective nonsurgical option with comparable long-term disease control. Lead author Nicholas van As, MD, MB, noted that few events occurred and the between-group difference was not statistically significant.

Sources: van As N, Patel J, Tree A, et al. Efficacy of radical prostatectomy versus stereotactic body radiotherapy (SBRT) for localised prostate cancer: results from an international phase III randomised controlled trial (PACE-A). Presented at: 2026 American Society for Radiation Oncology Annual Meeting; September 28, 2026; Boston, MA. Abstract LBA 32. Accessed September 29, 2026.

Clarke H. SBRT, prostatectomy show comparable long-term disease control in PACE-A trial. Urology Times. September 28, 2026. Accessed September 29, 2026.