Most patients with high-risk localized prostate cancer (HRLPC) do not undergo stereotactic body radiotherapy (SBRT) in part because of the limited evidence of long-term outcomes. We report long-term efficacy and toxicity outcomes for men treated with SBRT for HRLPC.
Individual patient data from ten prospective clinical studies evaluating SBRT for HRLPC across nine institutions were pooled in the Stereotactic Body Radiotherapy for High-Risk Localized Carcinoma of the Prostate consortium. The Kaplan-Meier method was used to estimate 5-yr biochemical recurrence (BCR) and distant metastasis (DM), stratified by receipt of intensified treatment (≥12 mo of androgen deprivation therapy [ADT] with extremely dose-escalated [≥8 Gy/fraction] prostate-directed SBRT). The impact of intensified treatment on BCR-free survival and DM-free survival was evaluated using multivariable Cox proportional hazards models. Late Common Terminology Criteria for Adverse Events grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity was analyzed using time-to-event models.
In 440 patients with a median follow-up time of 60.4 mo, 5-yr BCR and DM rates were 22% (95% confidence interval [CI] = 17-26%] and 9.2% (95% CI = 6.2-12%), respectively. In the 93 patients (21%) who received intensified treatment, 5-yr BCR and DM rates were 7.4% (95% CI = 1.7-13%) and 3.7% (95% CI = 0-7.9%), respectively. Receipt of intensified therapy was associated with a significant reduction in both BCR (hazard ratio [HR] = 0.38 [95% CI = 0.20-0.74], p = 0.005) and DM (HR = 0.43 [95% CI = 0.18-0.99], p = 0.049). For the overall cohort, 5-yr rates of grade ≥2 GU and GI toxicity were 23% (95% CI = 19-27%) and 10% (95% CI = 7-13%), respectively. Limitations include heterogeneous treatment techniques and the nonrandomized nature of the study.
The safety and efficacy profile of SBRT for HRLPC remains favorable at long-term follow-up, and SBRT should be integrated into shared decision-making for treatment of HRLPC.
European urology oncology. 2026 Apr 10 [Epub ahead of print]
Luca F Valle, Tahmineh Romero-Kalbasi, Tommy Jiang, Ritchell van Dams, Donald B Fuller, Andrew Loblaw, Thomas Kennedy, Sean P Collins, Vaibhav Sharma, Simeng Suy, Vedang Murthy, Indranil Mallick, Nicholas G Nickols, Neil Desai, Raquibul Hannan, Nima Aghdam, Irving David Kaplan, Kevin Stephans, Rahul Tendulkar, Steven Lau, Kekoa Taparra, Michael L Steinberg, Amar U Kishan
Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA., Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA., Department of Urology, Stanford Medicine, Stanford, CA, USA., Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA., Department of Radiation Oncology, Unio Specialty Care, San Diego, CA, USA., Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada., Division of Radiation Oncology, University of British Columbia, Kelowna, BC, Canada., Department of Radiation Oncology, University of South Florida, Tampa, FL, USA., Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India., Department of Radiation Oncology, Tata Memorial Hospital, Kolkata, India., Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Department of Radiation Oncology, New York University Langone Health, New York, NY, USA., Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA., Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA., Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA; UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. Electronic address: .