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August 17, 2025Open Access

Analysis of standard vs dose-escalated stereotactic body radiation therapy in localized prostate cancer: a comparative evaluation of survival outcomes

Key Points

The high-dose group showed no significant improvement in overall survival compared to controls, with rates of 66.7% vs. 83.4%.
In a 7-year follow-up, the dose-escalated group had a biochemical progression-free survival rate of 91.7%, while controls had 67.4%, despite nonsignificant results (p=0.497).
This observational analysis utilized propensity score matching to assess outcomes across both treatment groups, revealing comparable local control rates of 100% vs. 95.1%.
Findings suggest further prospective studies are needed to clarify the role of dose escalation in stereotactic body radiation therapy for localized prostate cancer.

Abstract

Background and purpose This study aimed to compare the safety and efficacy of high-dose biologically effective dose (BED) versus standard dose regimens in stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) using a propensity score matching (PSM) analysis. Methods Between June 2012 and February 2022, prostate-localized SBRT patients from two institutions were retrospectively reviewed. The high-dose group (n=12) received high-dose BED 1.5 (250Gy), and the control group (n=119) according to NCCN guidelines (35-37.5 Gy/5f, BED 1.5 198.3-225Gy). PSM was performed in a 1:4 ratio based on key clinical variables. Survival outcomes, including overall survival(OS), cancer-specific survival (CSS), biochemical progression-free survival (bPFS), local control (LC), and distant metastasis-free survival (DMFS)were analyzed using Kaplan-Meier methods with SPSS v26. Results In the 7-year follow-up, the high-dose group exhibited a 66.7% OS rate vs. 83.4% in controls (p=0.402) and an 88.9% CSS rate compared to 90.5% in controls (p=0.480). The high-dose group demonstrated a 91.7% 7-year bPFS rate, while controls had a 67.4% rate (p=0.497). Higher gleason score correlated with impaired biochemical control (p=0.028), and adverse NCCN classifications indicated suboptimal control (p=0.028). The high-dose group achieved a 100% 7-year LC rate vs. 95.1% in controls (p=0.569) and a 91.7% 7-year DMFS rate compared to 81.6% in controls (p=0.918). Patients with pre-existing health conditions were less likely to develop distant metastasis (p=0.047). Most patients tolerated SBRT with minimal toxicity, and no grade 3 or higher adverse events were observed. Conclusion Escalating the biologically effective dose above standard levels did not yield a significant improvement in tumor control or survival outcomes compared to conventional SBRT dosing for localized PCa. Further prospective studies are warranted to clarify the role of dose escalation in this setting.

Analysis of standard vs dose-escalated stereotactic body radiation therapy in localized prostate cancer: a comparative evaluation of survival outcomes

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Abstract

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