SBRT Alone for Prostate-Confined Cancer

Risk-Stratified Approach to SBRT Monotherapy

The National Comprehensive Cancer Network recommends SBRT monotherapy for low-risk prostate cancer (PSA <10 ng/mL, Gleason ≤6, clinical stage ≤T2a) confined to the prostate 1
Single institution series report 5-year biochemical progression-free survival of 95% for low-risk patients treated with SBRT alone 1
For low-intermediate risk disease (Gleason 7 with PSA <10 ng/mL OR Gleason 6 with PSA 10-20 ng/mL), SBRT monotherapy may be offered, according to the Journal of Clinical Oncology 4
Pooled analysis shows 5-year biochemical relapse-free survival of 84% for intermediate-risk patients 1
For unfavorable intermediate-risk disease, SBRT should be combined with 6 months of ADT rather than used alone, as recommended by the Annals of Oncology 5, 6
SBRT alone is NOT appropriate for high-risk prostate cancer (PSA >20 ng/mL, Gleason 8-10, or clinical stage ≥T3), according to the Annals of Oncology 2, 6
Level I evidence demonstrates that RT combined with ADT leads to significantly higher overall survival compared to RT alone in high-risk disease, as reported by the Annals of Oncology 2, 6
High-risk patients require at least 24 months of ADT in combination with radiation therapy, as recommended by the Annals of Oncology 5, 6

SBRT should only be performed at centers with appropriate technology, physics expertise, and clinical experience, according to the National Comprehensive Cancer Network 1
The technique requires image-guided delivery systems for precise targeting, as recommended by the National Comprehensive Cancer Network 1
Strict quality-assurance standards are necessary, as reported by the Journal of Clinical Oncology 7

Up to 50% of patients experience temporary bladder or bowel symptoms during treatment, according to the National Comprehensive Cancer Network 1
There is a low but definite risk of protracted rectal symptoms from radiation proctitis, as reported by the National Comprehensive Cancer Network 1
The risk of erectile dysfunction increases over time, according to the National Comprehensive Cancer Network 1