Five years on, stereotactic and conventional prostate radiotherapy left men with similar function

Design

Phase 3 international randomised trial, 5-year patient-reported outcomes

Population

Men with localised prostate cancer randomised to SBRT or conventional radiotherapy

Primary outcome

Patient-reported urinary, bowel and sexual function to 5 years

Effect

Pad-free 91% vs 90%; moderate/big bowel problems 5% vs 5%; adequate erections 17% vs 20%

PACE-B was an international phase 3 trial that randomised men with localised prostate cancer to stereotactic body radiotherapy (SBRT), given in five fractions, or conventionally fractionated radiotherapy (European Urology, July 2026). This report gives patient-reported outcomes to five years.

Urinary function was similar: leak-free 64% vs 69%, pad-free 91% vs 90%, and moderate or big leakage problems 6% vs 4% (SBRT vs conventional). Erections adequate for intercourse fell in both groups, from 35% to 17% with SBRT and from 40% to 20% with conventional radiotherapy. Moderate or big bowel problems were 5% in both at five years, and stool incontinence as a moderate or big problem was 2% vs 3%.

For men choosing radiotherapy, five fractions did not cost them more function at five years than a much longer conventional course. That supports discussing SBRT as an equal option, and it gives clear numbers to set expectations, especially about erectile decline.

• Discuss five-fraction SBRT as an option equal to conventional radiotherapy for suitable localised prostate cancer.
• Tell men that about 9 in 10 were pad-free at five years with either schedule.
• Warn that erections adequate for intercourse roughly halved by five years with both.
• Quote moderate or big bowel problems at about 1 in 20 at five years.
• Consider the travel and time savings of five fractions for men who live far from a radiotherapy centre.

Why it matters

Far fewer hospital visits with no extra long-term toxicity changes the practical choice for many men, particularly where travel is hard.

Don't overread it

These are descriptive patient-reported outcomes; the trial was not powered for small functional differences.

The statistics, in plain English

The percentages are based on men who returned questionnaires at five years, roughly 240-265 per group, so small differences between arms are within chance.

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