Pioneering ‘non-invasive’ prostate most cancers therapy as efficient as surgical procedure however with fewer main negative effects, trial reveals

Thousands of men with prostate cancer could avoid the debilitating urinary and sexual side effects associated with surgery thanks to a five-session radiotherapy treatment, researchers say. 

A first-of-its-kind study found that after eight years, 91 per cent of men who received the treatment showed no signs of their cancer returning – compared with just 84 per cent of those who had surgery. 

Patients who underwent the therapy also experienced less urinary incontinence and sexual dysfunction two years after treatment. 

For many diagnosed with the disease, removing the prostate is a powerful intervention. 

However, removing the gland means men who opt for surgery can’t conceive naturally. Almost all men also experience erectile dysfunction after the procedure. 

Stereotactic body radiation therapy (SBRT), meanwhile, uses advanced imaging to directly target tumours, while limiting exposure to nearby tissue. 

The treatment was approved for routine use on the NHS in June, but doctors at The Royal Marsden, who led the study, say too many men are still not made aware of their options. 

‘In our practice, patients generally meet both a surgeon and a radiation oncologist,’  said Dr Nicholas van As, a consultant clinical oncologist and study lead author. 

‘That does not happen everywhere. Patients should know that surgery is not their only curative treatment option and have the opportunity to discuss the benefits and side effects of both approaches.’ 

The PACE-A trial – presented at the annual meeting of the American Society for Radiation Oncology (ASTRO) – followed 123 men from eight centres across the UK between 2012 and 2022. 

Most had low or intermediate risk prostate cancer and were aged around 66. 

Patients were randomly assigned to undergo either a radical prostatectomy or five sessions of SBRT. Neither group received hormone therapy. 

Researchers monitored patients for any signs that their cancer had returned or worsened – including rising PSA levels – the spread of disease, the need for hormone treatment or prostate cancer-related death. 

Over the follow-up period there were just 13 treatment failures, including five among men treated with radiotherapy and eight among those who had surgery. 

Five years after treatment, rates of cancer returning were almost identical in both groups.  

After eight years, 91 per cent of men treated with radiotherapy were complication free, compared with 84 per cent of those who underwent surgery. 

However, the study was not designed to establish which treatment option was better at controlling the disease, meaning researchers cannot say the radiotherapy was definitively more effective overall. 

‘What we can say is that we saw very few cancer failures in either group, and that we have good data showing excellent cancer outcomes with five-treatment radiotherapy,’ Dr van As said. 

The team previously found that men treated with SBRT experienced less urinary incontinence and sexual dysfunction two years after treatment than those who underwent surgery, although bowel-related side effects were more common. 

The new study suggests those benefits continue in the longer term.  

Just 8 per cent of men treated with SBRT reported using at least one urinary pad at five years, compared with 48 per cent of those who had surgery. 

Bowel problems were also uncommon in both groups. 

Separate findings from the trial, also presented at ASTRO, focused on sexual function. 

Patient-reported sexual function scores declined in both groups over time, but remained significantly better after radiation. 

Five years after treatment, erectile-function scores – measured on a scale of 25 with higher scores indicating better function – were 19 for SBRT patients and five for surgery patients. 

Dr van As concluded: ‘We now have longer-term information on both cancer control and the functional outcomes that matter greatly to patients. 

‘This gives patients a much fuller picture of what to expect from each treatment.’ 

Dr Amar Kishan, a radiation oncologist who was not involved in the study, added: ‘This study 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.’ 

Prostate cancer is the most common cancer in men, with over 68,000 diagnosed each year in the UK.

But earlier this year, the UK National Screening Committee rejected proposals for a national prostate cancer screening programme. 

The committee argued that widespread screening could lead to over‑diagnosis and over‑treatment, exposing some men to the risks of impotence and incontinence when their tumour was unlikely to cause issues in their lifetime.