Exploration of Medicine

Table 2. Summary of the three Prostate Advances in Comparative Evidence (PACE) studies [67–70]

Study name	PACE-A	PACE-B	PACE-C
Treatment	SBRT (36.25 Gy/5 f) vs. surgery	SBRT (36.25 Gy/5 f) vs. conventional moderate hypofractionated EBRT (62 Gy/20 f or 78 Gy/39 f)	SBRT (36.25 Gy/5 f) vs. moderate hypofractionation (60 Gy/20 f)
Risk group	8% low 92% intermediate	9% low 91% favorable intermediate	35% high 65% intermediate
ADT	No	No	6-month ADT
Key results	GU/GI toxicity (see below). Sexual score by EPIC sexual domain, 62.3 (32.0–87.5) vs. 18 (13.8–40.3) at 24 m	Biochemical or clinical-failure-free rate 95.8% vs. 94.6%	Accrual completed, results pending
GU toxicity	6.5% vs. 50% reported use of urinary pads (P < 0.001)	26.9% vs. 18.3% (P < 0.001)	RTOG scale: 28% vs. 27%, P = 0.83 CTCAE scale: 34% vs. 28%, P = 0.038 (n.s.)
GI toxicity	Bowel scores by EPIC bowel domain [87.5 (79.2–100) vs. 100 (100–100)]	10.7% vs. 10.2% Grade 2+ in both arms (P = 0.94)	RTOG scale: 13% vs. 11%, P = 0.47 CTCAE scale: 17% vs. 10%, P = 0.0008
Conclusion	SBRT: less urinary incontinence, sexual bother, but slightly more bowel bother than prostatectomy	SBRT: non-inferior to conventional RT for intermediate-risk prostate cancer	GU and GI toxicities were comparable to the PACE-B trial, despite the larger prostate volume

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ADT: androgen deprivation therapy; CTCAE: common terminology criteria for adverse events; EPIC: The Expanded Prostate Cancer Index Composite; GI: gastrointestinal; GU: genitourinary; m: months; n.s.: non-significant; RT: radiation therapy; RTOG: Radiation Therapy Oncology Group; SBRT: stereotactic body radiation therapy; Gy: Gray is a unit of absorbed dose; m: months

Declarations

Author contributions

PT, KW, EY, and DL: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. ES, KJ, GO, AJT, PM, AD, and RK: Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

Kelvin Wong is a full-time employee of Astellas Pharma Canada, Inc. He was invited to assist with the literature review and drafting of this paper based on his scientific knowledge and experience in the therapeutic area. He does not have any conflicts to disclose aside from his employment with Astellas. No funding was received from Astellas for the drafting or publication of this paper. The assistance of Kelvin Wong in the drafting of this paper is solely in his individual capacity and is not a reflection of Astellas’ endorsement or approval of the paper’s content. Patricia Tai who is the Editorial Board Member and Guest Editor of Exploration of Medicine had no involvement in the decision-making or the review process of this manuscript. The remaining authors declare that they have no conflicts of interest.

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