Thousands of men with prostate cancer will now be offered high-powered radiotherapy on the NHS

NHS England will begin offering a five-session stereotactic body radiotherapy (SBRT) treatment for eligible men with early-stage, low or medium-risk prostate cancer within three months, according to a trial led by The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust. The PACE-B trial, a phase III international randomised study, found that SBRT—delivered in five sessions over two weeks—was as effective as 20 sessions of standard intensity-modulated radiotherapy (IMRT) in controlling cancer for five years, with 96% of SBRT patients and 95% of IMRT patients experiencing no recurrence or worsening of the disease.

SBRT uses multiple high-dose radiation beams targeted at tumors from different angles, minimizing damage to surrounding healthy tissue. It is approved for men with prostate cancer that has not spread beyond the prostate and carries a low or medium risk of growth. NHS England estimates that around 3,500 men annually will opt for SBRT over conventional radiotherapy, potentially freeing up 50,000 treatment appointments yearly if 1 in 5 eligible patients choose the shorter regimen.

What is SBRT and how does it differ from standard radiotherapy?

SBRT, also known as stereotactic ablative radiotherapy (SABR), delivers a concentrated radiation dose to cancer cells in fewer sessions compared to standard external radiotherapy. While IMRT typically requires 20 daily sessions over four weeks, SBRT reduces treatment to five sessions. The PACE-B trial, managed by the Clinical Trials and Statistics Unit at the Institute of Cancer Research, confirmed that both methods are equally effective in controlling low-risk, localized prostate cancer.

Why does this matter for patients and the NHS?

The shorter treatment duration reduces the burden on patients and healthcare systems. At five years post-treatment, 5.5% of SBRT patients experienced grade 2 or higher side effects affecting genital or urinary organs, compared to 3.2% in the IMRT group. Both groups had low gastrointestinal side effects. NHS England’s decision follows research demonstrating that SBRT maintains efficacy while cutting treatment time by up to 75%, allowing for more efficient resource allocation.

Royal Berkshire NHS Foundation Trust: Radiotherapy for prostate cancer

What may happen next?

With 48 NHS radiotherapy centers in England set to adopt SBRT, the focus will shift to patient uptake and long-term outcomes. Experts suggest the treatment could influence international guidelines, given its efficiency and safety profile. However, the NHS will need to monitor adherence to eligibility criteria, as SBRT is not suitable for cancers that have grown or spread beyond the prostate.

Did You Know? The PACE-B trial, which tested SBRT against IMRT, was a phase III international randomised study involving 1,300 patients across multiple countries, with five-year follow-up data published in 2024.

Expert Insight: The shift to SBRT reflects a broader trend in oncology toward precision treatments that balance efficacy with patient convenience. While the trial’s results are promising, the long-term impact on cancer recurrence rates and quality of life remains a key area for ongoing research, particularly as adoption expands beyond England.

Frequently Asked Questions

Who is eligible for SBRT under NHS England’s new policy?
Men with early-stage prostate cancer that has not spread beyond the prostate and is classified as low or medium risk of progression.

How many treatment sessions does SBRT require compared to standard radiotherapy?
SBRT requires five sessions over two weeks, while standard radiotherapy typically involves 20 sessions over four weeks.

What are the side effect rates for SBRT and IMRT?
At five years post-treatment, 5.5% of SBRT patients experienced grade 2 or higher side effects affecting genital or urinary organs, compared to 3.2% in the IMRT group.

How might the adoption of SBRT influence global cancer treatment practices?