For years, men diagnosed with prostate cancer have undergone extended radiation therapy, often requiring daily visits to the clinic over several weeks. But new research is offering a promising alternative. Short-course radiation, delivered in just five visits, has been shown to work just as well as the traditional, longer-term treatments involving up to 20 or more sessions spread across several weeks.
The method at the heart of this shift is known as hypofractionation. Unlike conventional radiation, which delivers smaller doses over a longer period, hypofractionated radiation uses higher doses per session, enabling treatment to be completed in a much shorter time frame. This approach is not only more convenient for patients but also shows similar long-term success rates, challenging the longstanding practice of prolonged radiation courses.
One form of hypofractionated treatment, called stereotactic body radiation therapy (SBRT), is gaining ground for its ability to target prostate cancer effectively within just a week. This technique uses highly focused beams of radiation delivered in fewer sessions, often just five, as opposed to the traditional 20 or more. Devices used for SBRT are marketed under various names, including CyberKnife, depending on the equipment being used, but all provide the same core benefit: rapid, effective treatment.
An SBRT session typically lasts between 20 to 30 minutes and feels very much like receiving an x-ray. To ensure the radiation is precisely delivered to the tumor while sparing healthy tissue, small markers known as fiducials—tiny metal pellets the size of rice grains—are placed in the prostate. These fiducials help the radiation machine accurately target the cancerous cells. During each session, the patient lies still while the machine rotates around their body, delivering radiation from multiple angles.
But does this new method of delivering radiation have the same effectiveness as traditional radiation? A recent clinical trial sought to answer this question by comparing the outcomes of patients treated with SBRT versus those who received conventional radiotherapy.
The study, which involved 874 men with localized prostate cancer (meaning the cancer had not spread beyond the prostate gland), found no significant difference in the long-term success of the two treatments. Men in the study ranged in age from 65 to 74, and all had prostate cancer with a low to intermediate risk of progression. They were randomly assigned to two groups:
Treatment Group: The 433 men in this group received SBRT, completing their radiation course in just five visits, spread across one to two weeks.
Control Group: The remaining 441 men underwent conventional radiotherapy, which was administered over four to 7.5 weeks.
None of the participants received additional treatments such as hormonal therapy, which is often used alongside radiation to block testosterone, a hormone that can fuel prostate cancer growth.
The results were striking. After a median follow-up period of 74 months (roughly six years), the incidence of cancer recurrence was nearly identical between the two groups. Of the men in the SBRT group, 26 developed visible signs of prostate cancer recurrence or experienced an increase in prostate-specific antigen (PSA) levels, suggesting that cancer had returned. In comparison, 36 men in the control group had similar recurrences. This means that 95.8% of men in the SBRT group and 94.6% of men in the control group remained free of prostate cancer during the study period.
This study provides robust evidence that short-course radiation therapy, such as SBRT, can be just as effective as the traditional longer treatments. The findings are a significant step toward improving the convenience and accessibility of prostate cancer treatment, offering patients a viable alternative that requires far less time commitment while maintaining the same high levels of effectiveness. As more patients opt for shorter treatment regimens, this approach could reshape the future of prostate cancer care, making it both more efficient and less burdensome for patients.
