Design: International phase 3 randomised trial, patient-reported outcomes
Population: Men with localised prostate cancer, about 250 per arm reporting at 5 years
Primary outcome: Patient-reported urinary, bowel and sexual function at 5 years
Effect: Pad-free 91% SBRT vs 90% CRT; moderate or big bowel problems 5% vs 5%

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

Urinary function was similar: pad-free rates were 91% with SBRT and 90% with conventional radiotherapy, and moderate or big leakage problems 6% and 4%. Moderate or big bowel problems rose from 2% at baseline to 5% in both groups. Erections adequate for intercourse fell from 35% to 17% with SBRT and from 40% to 20% with conventional treatment, and moderate or big sexual problems rose to 31% and 32%. Stool incontinence stayed at 2% to 3%.

For men choosing radiotherapy, five fractions rather than several weeks of daily attendance did not cost them function at five years. That matters especially where travel to a radiotherapy centre is long and costly, as for many patients in India, though SBRT needs image guidance and planning that not every centre has. The decline in erectile function was the same in both arms and should be part of every consent discussion.

Offer five-fraction SBRT as an option for suitable localised prostate cancer where it is available.
Tell men that five-year urinary and bowel function was similar with SBRT and conventional radiotherapy.
Discuss erectile decline frankly: the share with adequate erections roughly halved by five years in both arms.
Refer to a centre with image-guided SBRT if the patient prefers a shorter course.
Offer sexual health support from the start of treatment.

Why it matters

A one-week course with the same long-term function makes treatment more reachable for men far from a radiotherapy centre.

The statistics, in plain English

The trial reports proportions rather than formal comparisons for these outcomes, so similar percentages mean no meaningful difference was seen rather than proven equivalence. About 250 men per arm reported at five years, enough to see a large difference but not a very small one.