Stereotactic Body Radiation Therapy (SBRT) vs Radical Prostatectomy

How to cite: Haas JA. Stereotactic Body Radiation Therapy (SBRT) vs Radical Prostatectomy. Grand Rounds in Urology. October 23, 2025. Accessed Oct 2026. https://grandroundsinurology.com/stereotactic-body-radiation-therapy-sbrt-vs-radical-prostatectomy/

Summary

Jonathan A. Haas, MD, Clinical Professor and Department Chair, Radiation Oncology, New York University Grossman School of Medicine, Long Island, New York, presents a data-driven comparison of stereotactic body radiation therapy (SBRT) and radical prostatectomy for localized prostate cancer, focusing on screening, treatment necessity, outcomes, toxicity, quality of life, and cost. Dr. Haas argues that modern SBRT achieves oncologic outcomes comparable to surgery while offering advantages in patient-reported quality-of-life measures and treatment efficiency.

He begins by reviewing historical controversies surrounding prostate cancer screening, including US Preventive Services Task Force recommendations and later reassessment of key trials. Dr. Haas explains how reduced screening contributed to stage migration toward higher-risk disease and increased treatment costs, reinforcing the importance of effective treatment once cancer is detected.

Randomized and comparative data evaluating surgery versus radiation are reviewed, including PROTECT-T, which demonstrated equivalent prostate cancer–specific survival between surgery and external beam radiation therapy. Differences were primarily observed in side-effect profiles, with radiation associated with better preservation of sexual function. These findings provide the foundation for evaluating SBRT as a contemporary radiation modality.

Multiple randomized trials comparing SBRT with conventional and moderately hypofractionated radiation are discussed. These studies consistently demonstrate noninferior cancer control and comparable or improved gastrointestinal and genitourinary toxicity with SBRT, while substantially shortening treatment duration. Emerging data further show favorable patient-reported bowel and urinary quality-of-life outcomes.

Dr. Haas highlights the PACE-A randomized trial, the first to directly compare SBRT with radical prostatectomy. Early results show significantly better urinary continence and sexual function outcomes with SBRT, with similar rates of clinician-reported grade 2 or higher toxicity. While long-term oncologic outcomes are still maturing, these findings support informed shared decision-making.

Dr. Haas also addresses SBRT use across risk groups, emphasizing that androgen deprivation therapy remains important for higher-risk disease based on available prospective and pooled data. Institutional experience demonstrates that SBRT can be safely delivered even in patients with very large prostate glands, with transient toxicity and excellent biochemical control. He advocates collaborative, multidisciplinary prostate cancer care grounded in rigorous techniques, outcome reporting, and continuous innovation.

About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.