Nicholas van As, MD, MBBCH: The case for SBRT as a standard of care for localized prostate cancer

Stereotactic body radiotherapy (SBRT) has become a highly prominent method of treating early-stage cancer through 1 – 5 sessions of application. Recent research has shown it may even be optimized in combination with radiotherapy and antigen deprivation therapy (ADT) to improve progression-free survival while maintaining low risk of toxicity and function impact on men with prostate cancer.

As one prominent radiation oncologist recently attested, SBRT should possibly be considered the standard of care for localized prostate cancer.

In an interview with Urology Times, Nicholas van As, MD, MBBCH, medical director of The Royal Marsden NHS Foundation Trust, discussed his American Society for Radiation Oncology (ASTRO) 2024 Annual Meeting presentation on the evidence supporting priority of SBRT in localized prostate cancer. Particularly, van As described the “evolution” of SBRT for prostate cancer—from a traditional 1.8 – 2 Gy fractionated dose over 7-8 weeks, to hypofractionated regimens that have reduced the time to treatment completion without inducing greater toxicity in patients.

Investigators have also been able to assure a non-inferior, if not improved, rate of patient function in sexual and gastrointestinal domains following hypofractionated SBRT for prostate cancer.

“I think that's now given us the confidence to say that in this group of men—and this was men with intermediate-risk, localized prostate cancer—that SBRT can be considered as a standard of care option,” van As explained.

That said, there may remain some safety-related pushback from colleagues on that suggestion. Van As acknowledged clinicians may point to marks of worsened 2-year urinary toxicity in treated patients relative to standard care—a mark which van As noted was resolved by year 5 in the same patients. For whatever concern remains around SBRT, he stressed that the cost-effective, convenient and efficacious outcomes associated with it should outweigh them.

“It's a big difference in both cost and utilization of service,” he said. “So, I think most people are believers and are supportive, but there are always those who don't think it's the right way. In the US, there are funding issues, obviously—some people are paid per fraction, and obviously, therefore some providers are going to be less reluctant to do it. But I think the evidence is pretty clear now that this should be at least an option and offered to patients.”