PACE-B at five years: stereotactic and conventional radiotherapy give similar patient-reported urinary and bowel outcomes

Design

Phase 3 randomised trial, patient-reported outcomes at 5 years

Population

Men with localised prostate cancer randomised to stereotactic body radiotherapy or conventionally fractionated radiotherapy

Primary outcome

Urinary, sexual and bowel patient-reported outcomes from baseline to 5 years

Effect

Pad-free 91% versus 90%; adequate erections 35% to 17% versus 40% to 20%

The phase 3 PACE-B trial randomised men with localised prostate cancer to stereotactic body radiotherapy or conventionally fractionated radiotherapy. This report gives patient-reported outcomes from baseline to five years, presented as waffle charts to line up with surgical outcome reporting.

At five years, leak-free rates were 64% (164 of 258) after stereotactic and 69% (172 of 249) after conventional treatment. Pad-free rates were 91% and 90%. Moderate or big leakage problems were reported by 6% and 4%. Erections adequate for intercourse fell from 35% to 17% (stereotactic) and from 40% to 20% (conventional). Moderate or big sexual problems rose from 24% to 31% and from 22% to 32%. Moderate or big bowel problems were 5% and 5% at five years, from 2% at baseline.

The abstract reports descriptive proportions without tests of difference, and responders fell over time, so the figures are best read as broad comparability, not equivalence. Cancer control outcomes are reported separately.

• Pad-free rates at five years were 91% (stereotactic) and 90% (conventional).
• Erections adequate for intercourse roughly halved in both groups.
• Moderate or big sexual problems rose to about one in three.
• Moderate or big bowel problems were around 5% in both groups.
• Counsel men on sexual function decline with either radiotherapy approach.

Why it matters

Patients choosing between surgery and radiotherapy can now compare five-year experience in the same visual format.

Don't overread it

These are descriptive patient-reported outcomes and do not address cancer control or whether the schedules are equivalent.

The statistics, in plain English

The abstract reports percentages from questionnaires without confidence intervals, so small differences such as 64% versus 69% leak-free cannot be judged. Fewer men answered at five years than at baseline, which can bias results towards those doing well.

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