The PACE-B phase 3 international RCT compared patient-reported outcomes (PROMs) at 5 years in men with localised prostate cancer randomised to stereotactic body radiotherapy (SBRT) vs. conventionally fractionated radiotherapy (CRT).
At 5 yr, urinary pad-free rates were 91% (SBRT) vs. 90% (CRT); intercourse-adequate erections declined from ~35–40% at baseline to ~17–20% in both arms; moderate/big bowel problems remained low at 5% in both groups; stool incontinence as a moderate/big problem rose from <1% to 2–3% in both arms.
- Abstract-only data; full methodology, statistical comparisons, and confidence intervals are not reported here. - No surgical comparator arm within this trial; cross-trial comparisons with prostatectomy PROMs carry inherent confounding. - Loss to follow-up at 5 yr is substantial (response denominators notably smaller than baseline), which may bias PROM estimates.
SBRT and CRT produce broadly similar 5-yr urinary, bowel, and sexual outcomes for localised prostate cancer — reassuring for shared decision-making. Clinicians should counsel patients that erectile function declines meaningfully in both modalities regardless of fractionation schedule.
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