Trial shows new radiotherapy treatment could benefit prostate cancer patients

Results of research into new radiotherapy treatment offer new hope to tens of thousands of prostate cancer patients.

Prostate cancer* is the number one cancer in males and every year more than 55,000 men are diagnosed with the disease in the UK.

The cancer is curable if caught early and currently most patients undergo 20 days of radiotherapy treatment - Monday to Friday, over a four-week period.

Recent evidence from an international randomised control phase III trial involving patients from University Hospitals Coventry and Warwickshire (UHCW) NHS Trust has shown that higher doses of targeted radiotherapy given each day over five days (called Stereotactic Body Radiotherapy – SBRT) has a high equivalent cure rate compared with the standard four-week course of radiotherapy treatment.

The PACE trials** have been looking at establishing the new five-fraction SBRT treatment as the standard for localised prostate cancer.

Andrew Chan, Consultant Clinical Oncologist at UHCW NHS Trust, says data from the trial, which has involved more than 870 prostate cancer patients across the world, is very encouraging.

“This is a pivotal, practice-changing result because it means that for this highly prevalent cancer we are able to reduce radiotherapy treatment to only a quarter of the current standard – from 20 days to five days – with the same clinical benefits,” he said. “That would be such a game changer for both patients and for the NHS in terms of less visits to hospital so patients can return to their usual activities quicker than normal and it generates more capacity for treatment.”

A paper highlighting the findings of this Prostate SBRT study were published in the New England Journal of Medicine,*** one of the world’s most prestigious peer reviewed publications.

Dr Chan, the local principal investigator for the PACE-B study, explained that the five-year biochemical-clinical failure free cure rate was 96% with five days of SBRT treatment, which is noninferior to the current standard treatment.

He said: “This contemporary data with such a high cure rate is a combination of the advances in radiotherapy and the quality assurance that ensures our radiotherapy planning and image guidance are world class. These have all been a credit to our clinicians and radiotherapy team members.

"Many patients from this Trust were recruited to this trial and this has been a way of establishing the level 1 evidence we need to support SBRT in prostate cancer. We have people who have benefited from this treatment and the first patient, who was treated in 2016, is doing very well. SBRT is now our standard treatment for men with low risk and low-intermediate risk prostate cancer not requiring concurrent hormone therapy.”

One of the patients invited to take part in the SBRT trial, Willy Goldschmidt, says being given the opportunity to receive the condensed radiotherapy schedule was ‘life changing’.

Willy was diagnosed with prostate cancer in 2017. Following his diagnosis, he met with consultant urologist, Mr Donald MacDonald, who presented him with two curative options: surgery or radiotherapy.

Willy said: “During an appointment with the oncology team, which was also attended by research radiographer Vicky Sturgess, I was introduced to the SBRT trial, offering the option of a condensed radiotherapy schedule – five treatments over two weeks instead of the standard 20 over four weeks.

“The idea of a condensed radiotherapy schedule sounded appealing, with fewer hospital visits and no invasive surgery to recover from. I accepted the offer, and when I found out I had been randomly selected to the SBRT arm of the trial I was delighted.

“The shorter treatment schedule had minimal impact on my daily life, and I was able to carry on with my day-to-day activities as normal. I felt very well supported throughout the process and was reassured by the clinical staff at every stage of the treatment.

“Being part of the trial means I still have follow-up checks, and my latest follow up on 7^th October came back with an all-clear result. I’m now eight years on from my initial diagnosis and treatment, and it’s safe to say the treatment and follow up monitoring has been life changing for me in that it has removed any concerns I might have had about this potentially lethal disease.

“I feel privileged to have been given the opportunity to take part in a trial that could change prostate cancer treatment for others. I now volunteer as a Research Champion for the Trust and fully advocate patients taking part in research trials.”  

* Prostate cancer is a global healthcare challenge, with nearly 1.5 million men receiving a diagnosis annually. In England in 2021, a total of 12% of newly diagnosed prostate cancers were low risk and 29% were intermediate risk. Patients have several treatment options, including radiotherapy, which is considered to be curative in most patients.

** The Prostate Advances in Comparative Evidence (PACE-B) trial in Stereotactic Body Radiotherapy is a Phase 3 international trial with 874 patients. It is led in the UK by the Royal Marsden Hospital.

*** Phase 3 Trial of Stereotactic Body Radiotherapy in Localized Prostate Cancer | New England Journal of Medicine