Five-year side effects after prostate SBRT similar to conventional radiotherapy, and 5-ARIs on active surveillance

The edition in brief

In 97 men from a phase II trial who went on to prostatectomy, multiparametric MRI and PSMA-PET/CT each had high specificity but low sensitivity segment by segment, and combining them raised sensitivity from 13% to 26%. A single-institution active surveillance cohort of 1,938 men with Grade Group 1 cancer found larger prostates and 5-alpha reductase inhibitor use associated with less grade progression and less definitive treatment, which supports treating urinary symptoms with these drugs during surveillance. The practice-changer is the five-year patient-reported outcome analysis of the phase 3 PACE-B trial: men given five-fraction stereotactic body radiotherapy reported the same pad-free rates (91% vs 90%), bowel problems (5% each) and erectile decline as those given conventional fractionation, supporting SBRT as an option with a far shorter course.