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News
For the first time, men with localized prostate cancer have randomized head-to-head data comparing surgery and radiation. The PACE-A phase 3 trial found SBRT and prostatectomy delivered similar 8-year cancer control, but SBRT came out far ahead on quality of life — with dramatically less urinary incontinence and much better sexual function preserved. The takeaway: both options work, but the side-effect profiles are strikingly different.
For decades, men diagnosed with localized prostate cancer have had to choose between surgery and radiation without any direct randomized evidence to guide them. The PACE-A trial — the first phase 3 head-to-head comparison — is changing that conversation. Presented at the ASTRO 2026 Annual Meeting in Boston, the trial enrolled 123 UK men with low- or intermediate-risk prostate cancer and randomly assigned them to either radical prostatectomy or stereotactic body radiotherapy (SBRT, delivered in just five fractions over 1–2 weeks).
After a median follow-up of 8 years, both treatments showed excellent and comparable cancer control. But when it came to side effects, SBRT pulled well ahead — with far less urinary leakage and significantly better sexual function preserved.
By the Numbers:
Why it matters: This is the first randomized evidence directly comparing these two standard treatments, giving clinicians and patients a clearer, evidence-based framework for shared decision-making. Researchers stress that both options remain valid — but for men prioritizing quality of life, SBRT offers a compelling advantage.
